Manor Care of Williamsport PA (North) LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

901502 Issued in PA

Legal business name

MANOR CARE OF WILLIAMSPORT PA (NORTH) LLC

Practice address

300 Leader Dr
Williamsport, PA 17701-1943

Phone

(570) 323-8627

Fax

(570) 323-5820

NPI assigned

May 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Martin D Allen

Title

Director

Phone

(419) 252-5743

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ManorCare Health Services - Williamsport North Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494288000000",
    "number": "1023064193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436042615",
            "telephone_number": "419-252-5500",
            "fax_number": "877-385-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LEADER DR",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011943",
            "telephone_number": "570-323-8627",
            "fax_number": "570-323-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANOR CARE OF WILLIAMSPORT PA (NORTH) LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2017-05-09",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "419-252-5743",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "901502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1020618210001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ManorCare Health Services - Williamsport North",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kenia A Maldonado Vergara, MD
• Christine Manenkoff
• Morgan Manglaviti, PA-C
• Jennifer Manning, DPT
• Kiersten Manno, M.S.
• Manor Care of Williamsport PA (South) LLC
• Kathleen Victoria Marabella
• Michael Marceau, MD
• Marcus Riedhammer, MD, PC
• Lucas Charles Mariano, CRNP

• Skilled Nursing Facility in Williamsport, PA
• Providers in Williamsport, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.