Williamsport Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

491902 Issued in PA

Legal business name

WILLIAMSPORT HOME

Practice address

1900 Ravine Rd
Williamsport, PA 17701-1799

Phone

(570) 323-8781

Fax

(570) 323-4858

NPI assigned

Jul 22, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Donald S. Pote, NHA

Title

Executive Director

Phone

(570) 323-8781

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Skilled nursing facility certification: CCN 395678

Legal name

WILLIAMSPORT HOME

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Nov 1, 1984

Last certification

Feb 28, 2025

Beds

129

Ownership / control type

Other Nonprofit

Organization structure

CorporationNon-profit

Incorporated

Jan 5, 1940 in PA

Enrollment address

1900 Ravine Rd
Williamsport, PA 17701-1799

Nursing home name

WILLIAMSPORT HOME, THE

Listed as

Williamsport Home, TheCCN 395678

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

3 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Other

Certified

Nov 1, 1984

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

129118.1 residents per day on average

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• County of Indiana

  • Skilled Nursing Facility
  • Indiana, PA
  • NPI 1942283528

  Affinity Health Services

  CMS ownership
• Jewish Home of Eastern Pennsylvania

  • Skilled Nursing Facility
  • Scranton, PA
  • NPI 1235137472

  Affinity Health Services

  CMS ownership

Practitioners 2

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

• Lee Michael Ciccarelli, M.D.

  • Specialist
  • Williamsport, PA
  • NPI 1417909029
  NPD (past)
• Brandon M Roscoe, M.D.

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

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Lee Michael Ciccarelli, M.D.

  • Specialist
  • Williamsport, PA
  • NPI 1417909029

  Nursing home

  Care Compare affiliation
• Russell Lewis Gombosi, MD

  • Internal Medicine Physician
  • Williamsport, PA
  • NPI 1528078433

  Nursing home

  Care Compare affiliation
• Brandon M Roscoe, M.D.

  • Family Medicine Physician
  • Du Bois, PA
  • NPI 1639394034

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320364800000",
    "number": "1336149129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 RAVINE RD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011799",
            "telephone_number": "570-323-8781",
            "fax_number": "570-323-4858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 RAVINE RD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011799",
            "telephone_number": "570-323-8781",
            "fax_number": "570-323-4858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSPORT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2011-11-04",
        "status": "A",
        "authorized_official_last_name": "POTE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "570-323-8781",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "491902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY",
            "identifier": "800632",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0007492980001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sasha N Williamson, RDH, PHDHP
• Williamsport Area Ambulance Service Cooperative
• Williamsport Area School District
• Williamsport Dental & Dentures, Inc
• Williamsport Family Medical Center, LLC
• Williamsport North Operations LLC
• Williamsport North SNF Operations LLC
• Williamsport Obstetrics & Gynecology, P.C.
• Williamsport Orthopedic & Prosthetic Company Inc
• Williamsport Pathology Assocs.

• All providers in Williamsport, PA
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.