Op Selinsgrove, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

040302 Issued in PA

Legal business name

OP SELINSGROVE, LLC

Doing business as

The Manor at Penn Village

Practice address

800 Broad St
Selinsgrove, PA 17870-1216

Phone

(570) 374-8181

Fax

(570) 372-2398

NPI assigned

Jun 8, 2006

Organization subpart

No

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

Authorized official

Name

Joseph Conte

Title

Chief Operating Officer

Phone

(407) 571-1550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Manor at Penn Village Doing business as

Tax ID family

Op Selinsgrove LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pennknoll Village Facility Operations, LLC

  dba Pennknoll Village

  • Skilled Nursing Facility
  • Everett, PA
  • NPI 1134135577
  NPD tax ID

Locations

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225078009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CONCOURSE PKWY S",
            "address_2": "SUITE 800",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327516148",
            "telephone_number": "407-571-1550",
            "fax_number": "407-571-1599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 BROAD ST",
            "city": "SELINSGROVE",
            "state": "PA",
            "postal_code": "178701216",
            "telephone_number": "570-374-8181",
            "fax_number": "570-372-2398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OP SELINSGROVE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CONTE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "407-571-1550"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "040302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1012269900001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Manor at Penn Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dennis A Nicolette, DMD
• Angela Jo O'Brien, LSW
• Edward Thomas O'Brien, M.D.
• Rebecca O'Hara, DPT
• Old Trail Imaging, LLC
• Charles Carl Pagana, MD
• Charles Michael Pagana II, MD
• James Dylan Pagana, MD
• Reeti Parikh, DMD
• Mayur A Patel, M.D.

• Skilled Nursing Facility in Selinsgrove, PA
• Providers in Selinsgrove, 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 Aug 22, 2020; 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.