Susquehanna Village Facility Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SUSQUEHANNA VILLAGE FACILITY OPERATIONS, LLC

Doing business as

Manor at Susquehanna Village

Practice address

990 Medical Rd
Millersburg, PA 17061-1235

Phone

(717) 692-4751

Fax

(717) 692-4588

NPI assigned

Jul 27, 2006

Organization subpart

No

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

Authorized official

Name

Kenneth Ussery

Title

Authorized Official

Phone

(407) 571-1550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Manor at Susquehanna Village Doing business as

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499385600000",
    "number": "1669496287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CONCOURSE PKWY S",
            "address_2": "SUITE 200",
            "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": "990 MEDICAL RD",
            "city": "MILLERSBURG",
            "state": "PA",
            "postal_code": "170611235",
            "telephone_number": "717-692-4751",
            "fax_number": "717-692-4588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA VILLAGE FACILITY OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2017-07-07",
        "status": "A",
        "authorized_official_last_name": "USSERY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "407-571-1550"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1018126480001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manor at Susquehanna Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hoyt Stiely, PHARMACY INTERN
• Erin Elizabeth Stone, DPT
• Tynneyl Stoneroad, M.A.
• Cynthia Joann Stout, RPH
• Allyson Stutzman, M.S. CCC-SLP
• Carrie A Sydow, COTA/L
• Ahmed Tarique, MD
• Vicky Tribbitt, PT
• Tonya D Varner, ATC, CMT
• Kaitlyn Waclawski

• Skilled Nursing Facility in Millersburg, PA
• Providers in Millersburg, 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 Jul 7, 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.