Provider Demographics
NPI:1861521627
Name:SUSQUEHANNA VENTURES, INC.
Entity type:Organization
Organization Name:SUSQUEHANNA VENTURES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-320-7661
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:SUSQUEHANNA HOME MEDICAL PO
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:570-320-7660
Mailing Address - Fax:570-320-7659
Practice Address - Street 1:1201 GRAMPIAN BLVD
Practice Address - Street 2:SUSQUEHANNA HOME MEDICAL PO
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1900
Practice Address - Country:US
Practice Address - Phone:570-320-7660
Practice Address - Fax:570-320-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413352L335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA815788OtherBLUE CROSS FPH
PA1007515570011Medicaid
PA0519900001Medicare ID - Type Unspecified