Locust Grove Facility Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LOCUST GROVE FACILITY OPERATIONS, LLC

Practice address

69 Cottage Rd
Mifflin, PA 17058-7030

Phone

(717) 436-8921

Fax

(717) 436-9165

NPI assigned

Jul 31, 2006

Organization subpart

No

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

Authorized official

Name

Tim Lehner

Title

Manager

Phone

(770) 698-9040

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Locust Grove Retirement Village Doing business as

Electronic endpoints 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Laurie A. Cox, M.D.

  • Family Medicine Physician
  • Belleville, PA
  • NPI 1881660124
  NPD (past)
• Brandon M Roscoe, M.D.

  • Family Medicine Physician
  • Du Bois, PA
  • NPI 1639394034
  NPD (past)

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1265448690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 COTTAGE RD",
            "city": "MIFFLIN",
            "state": "PA",
            "postal_code": "170587030",
            "telephone_number": "717-436-8921",
            "fax_number": "717-436-9165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 COTTAGE RD",
            "city": "MIFFLIN",
            "state": "PA",
            "postal_code": "170587030",
            "telephone_number": "717-436-8921",
            "fax_number": "717-436-9165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOCUST GROVE FACILITY OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "LEHNER",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-698-9040"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1018114080001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "800 Concourse Pkwy S Ste 200",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Locust Grove Retirement Village",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Locust Grove Retirement Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Johnathan Michael Hau, COTA
• Olalee M Hornberger, COTA/L
• Katelyn Hoylman, M.S., CF-SLP
• Juniata Agape Ministries Inc
• Amy K Lesh
• Kelsey Renee Martin, CPM
• Lori M. O'Shaughnessy, CRNP
• Op Mifflin, LLC
• Rebecca Diane Rhine, DPT
• Lionel Varela

• Skilled Nursing Facility in Mifflin, PA
• Providers in Mifflin, 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 Sep 13, 2024; 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.