Susquehanna Valley Nursing and Rehabilitation Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

084802 Issued in PA

Legal business name

SUSQUEHANNA VALLEY NURSING AND REHABILITATION CENTER LLC

Practice address

745 Chiques Hill Road
Columbia, PA 17512-8411

Phone

(717) 684-7555

Fax

(717) 684-3677

NPI assigned

Mar 23, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Stephen L. Diffenderfer, NHA

Title

Nursing Home Administrator

Phone

(717) 684-7555

Specialties & licenses 1

Addresses

Other identifiers 2

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

CLIA laboratory certificates

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346112000000",
    "number": "1689633943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 CHIQUES HILL RD",
            "city": "COLUMBIA",
            "state": "PA",
            "postal_code": "175128411",
            "telephone_number": "717-684-7555",
            "fax_number": "717-684-3677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 CHIQUES HILL ROAD",
            "city": "COLUMBIA",
            "state": "PA",
            "postal_code": "175128411",
            "telephone_number": "717-684-7555",
            "fax_number": "717-684-3677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA VALLEY NURSING AND REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-23",
        "last_updated": "2012-08-28",
        "status": "A",
        "authorized_official_last_name": "DIFFENDERFER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "NURSING HOME ADMINISTRATOR",
        "authorized_official_telephone_number": "717-684-7555",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "084802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11011465300001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011465300001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Columbia, PA
• Providers in Columbia, 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 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.