1033101803 NPI number — MARIA JOSEPH MANOR

Table of content: (NPI 1033101803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033101803 NPI number — MARIA JOSEPH MANOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIA JOSEPH MANOR
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:
EMMANUEL CENTER FOR NURSING & REHABILITATION @ MARIA JOSEPH 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:
1033101803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
875 MONTOUR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17821-9148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-275-4221
Provider Business Mailing Address Fax Number:
570-275-5616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 SCHOOLHOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17821-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-275-6100
Provider Business Practice Location Address Fax Number:
570-275-9057
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HRUBY
Authorized Official First Name:
SISTER MARGUERITE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
570-275-6100

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  391302 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100730379003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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