Provider Demographics
NPI:1487911830
Name:RELIANT WHITE CLIFF HOLDINGS, LLC
Entity type:Organization
Organization Name:RELIANT WHITE CLIFF HOLDINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:MYZAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-558-3700
Mailing Address - Street 1:3601 ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-3228
Mailing Address - Country:US
Mailing Address - Phone:215-558-3700
Mailing Address - Fax:215-558-3701
Practice Address - Street 1:110 FREDONIA RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-7911
Practice Address - Country:US
Practice Address - Phone:724-588-8090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility