39D2246008 CLIA NUMBER - ST JOSEPHS CENTER

Laboratory Demographics

CLIA Number: 39D2246008

Facility Name: ST JOSEPHS CENTER

Facility Address:
2010 ADAMS AVENUE
SCRANTON, PA
ZIP 18509
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Facility Phone Number: 570 342-8379

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1053779561

Taxonomy: 3140N1450X - Skilled Nursing Facility
A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment.

CLIA Record

Field Name	Field Value
CLIA Number	39D2246008
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	ST JOSEPHS CENTER
Street	2010 ADAMS AVENUE
City	SCRANTON
State	PA
ZIP	18509
Phone	570 342-8379
CertificateType	4
CertificateEffectiveDate	12/20/2023
CertificateExpirationDate	12/19/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024