Provider Demographics
NPI:1538194519
Name:SUREHEALTH LTC LLC
Entity type:Organization
Organization Name:SUREHEALTH LTC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MESSINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-271-7285
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:MC 24-15
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-2415
Mailing Address - Country:US
Mailing Address - Phone:570-271-7965
Mailing Address - Fax:570-271-7370
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:MC 24-15
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-271-7965
Practice Address - Fax:570-271-7370
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUREHEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415549L3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101138074-0001Medicaid
PA0397614OtherPACE