1711 EAST BROAD STREET OPCO LLC
NPI 1356159206
Skilled Nursing Facility in Hazleton, PA

Active since December 24, 2024
1711 E BROAD ST, HAZLETON, PA 18201(570) 453-5100(570) 453-5138 Get Directions Write a Review

NPPES record last updated: March 10, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 10, 2025, Feb 28, 2025, Dec 24, 2024 (3 updates tracked since 2024).

About 1711 East Broad Street Opco Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

1711 EAST BROAD STREET OPCO LLC (NPI 1356159206), doing business as The Manor At St. Luke Village, is a healthcare organization registered as a skilled nursing facility in Hazleton, Pennsylvania and active in the NPI registry since December 2024. The organization lists Tiffany Hoback, Manager, as its authorized official.

NPPES Registry Identity

NPI1356159206
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business Name1711 EAST BROAD STREET OPCO LLC
Location Address1711 E BROAD STHazleton, PA 18201-5691
Mailing Address1711 E Broad StHazleton, PA 18201-5691 · (570) 453-5100 · Fax (570) 453-5138
Fax(570) 453-5138
Organization SubpartNo
Authorized OfficialTiffany HobackManager · (770) 698-9040
Enumeration DateDecember 24, 2024
Last NPPES UpdateMarch 10, 20253 updates tracked since enumeration
NPPES CertifiedMarch 10, 2025
NPI 1356159206 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
1711 E BROAD ST, Hazleton, PA 18201

Other Names 1

Doing Business AsThe Manor At St. Luke Village

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Occupational Therapist
1711 E BROAD ST
HAZLETON, PA 18201
Skilled Nursing Facility
1711 E BROAD ST
HAZLETON, PA 18201
Physical Therapy Assistant
1711 E BROAD ST
HAZLETON, PA 18201
Occupational Therapy Assistant
1711 E BROAD ST
HAZLETON, PA 18201
Physical Therapy Assistant
1711 E BROAD ST
HAZLETON, PA 18201
Occupational Therapist
1711 E BROAD ST
HAZLETON, PA 18201
Physical Therapy Assistant
1711 E BROAD ST
HAZLETON, PA 18201
Physical Therapist
1711 E BROAD ST
HAZLETON, PA 18201

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is 1711 East Broad Street Opco LLC's NPI number?

The NPI number for 1711 East Broad Street Opco LLC is 1356159206. It was assigned to this organization in the NPPES registry on December 24, 2024. The provider is doing business as The Manor at St. Luke Village.

Where is 1711 East Broad Street Opco LLC located?

1711 East Broad Street Opco LLC is located at 1711 E Broad St, Hazleton, PA 18201. The listed phone number is (570) 453-5100.

What is 1711 East Broad Street Opco LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

When was this NPI record last updated?

The NPPES record for 1711 East Broad Street Opco LLC was last updated on March 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.