1114960515 NPI number — WILLOW MANOR NURSING HOME, INC.

Table of content: (NPI 1114960515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114960515 NPI number — WILLOW MANOR NURSING HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLOW MANOR NURSING HOME, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WILLOW MANOR
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114960515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNETT SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19348-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-925-4436
Provider Business Mailing Address Fax Number:
610-925-4351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 PRINCETON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01851-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-454-8086
Provider Business Practice Location Address Fax Number:
978-453-9772
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DROPESKEY
Authorized Official First Name:
JANE
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE MANAGER
Authorized Official Telephone Number:
610-925-4231

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0701 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0940330 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2222551101 . This is a "BC/BS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018329 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31584 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 802277 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2222551110 . This is a "BC/BS - OUTPATIENT REHAB" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 71-00029 . This is a "UNITED - EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 551976 . This is a "AETNA-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 903194 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".




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