Provider Demographics
NPI:1699902783
Name:FCC ALLENWOOD
Entity type:Organization
Organization Name:FCC ALLENWOOD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAINO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:570-547-7950
Mailing Address - Street 1:PO BOX 2500
Mailing Address - Street 2:ROUTE 15, 2 MILES NORTH
Mailing Address - City:WHITE DEER
Mailing Address - State:PA
Mailing Address - Zip Code:17887-2500
Mailing Address - Country:US
Mailing Address - Phone:570-547-7950
Mailing Address - Fax:570-547-7710
Practice Address - Street 1:ROUTE 15 RUSSELL ROAD
Practice Address - Street 2:
Practice Address - City:ALLENWOOD
Practice Address - State:PA
Practice Address - Zip Code:17810-2500
Practice Address - Country:US
Practice Address - Phone:570-547-7950
Practice Address - Fax:570-547-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility