Provider Demographics
NPI:1033529490
Name:BUFFALO VALLEY LUTHERAN VILLAGE
Entity Type:Organization
Organization Name:BUFFALO VALLEY LUTHERAN VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THREAPY ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:OTA
Authorized Official - Phone:570-523-4226
Mailing Address - Street 1:131 FOREST HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-7004
Mailing Address - Country:US
Mailing Address - Phone:570-412-5064
Mailing Address - Fax:
Practice Address - Street 1:189 E TRESSLER BLVD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9272
Practice Address - Country:US
Practice Address - Phone:570-523-4226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006155314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility