Provider Demographics
NPI:1245502814
Name:JDK MANAGEMENT COMPANY, LP
Entity type:Organization
Organization Name:JDK MANAGEMENT COMPANY, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT HEALTHCARE ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:R
Authorized Official - Last Name:REICHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-784-0111
Mailing Address - Street 1:1388 STATE ROUTE 487
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8953
Mailing Address - Country:US
Mailing Address - Phone:570-784-0111
Mailing Address - Fax:570-784-4785
Practice Address - Street 1:1388 STATE ROUTE 487
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8953
Practice Address - Country:US
Practice Address - Phone:570-784-0111
Practice Address - Fax:570-784-4785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA399004Medicare Oscar/Certification