Provider Demographics
NPI:1528061785
Name:MOUNTAIN VIEW NURSING HOME, INC.
Entity type:Organization
Organization Name:MOUNTAIN VIEW NURSING HOME, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOC VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MCQUILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-214-9790
Mailing Address - Street 1:2309 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-3686
Mailing Address - Country:US
Mailing Address - Phone:570-341-0050
Mailing Address - Fax:570-341-0051
Practice Address - Street 1:2309 STAFFORD AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-3686
Practice Address - Country:US
Practice Address - Phone:570-341-0050
Practice Address - Fax:570-341-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA053602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013905550001Medicaid
PA39-5881Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PA1048610001Medicare NSC