Provider Demographics
NPI:1073500963
Name:WOOD RIVER PROPERTY LLC
Entity Type:Organization
Organization Name:WOOD RIVER PROPERTY LLC
Other - Org Name:WOOD RIVER VILLAGE NURSING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCEVILLY
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:215-752-2370
Mailing Address - Street 1:3200 BENSALEM BLVD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1956
Mailing Address - Country:US
Mailing Address - Phone:215-752-2370
Mailing Address - Fax:215-752-1672
Practice Address - Street 1:3200 BENSALEM BLVD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1956
Practice Address - Country:US
Practice Address - Phone:215-752-2370
Practice Address - Fax:215-752-1672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA233802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0002078000OtherINDEPENDENCE BLUE CROSS
PA5312656OtherAETNA
PA395864Medicare Oscar/Certification