Provider Demographics
NPI:1073501128
Name:D. P. DODDS ASSOCIATES, INC.
Entity Type:Organization
Organization Name:D. P. DODDS ASSOCIATES, INC.
Other - Org Name:CONNER-WILLIAMS NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DODDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-521-1331
Mailing Address - Street 1:105 MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-2409
Mailing Address - Country:US
Mailing Address - Phone:610-521-1331
Mailing Address - Fax:610-521-3863
Practice Address - Street 1:105 MORTON AVE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-2409
Practice Address - Country:US
Practice Address - Phone:610-521-1331
Practice Address - Fax:610-521-3863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009120920001Medicaid
PA396099Medicare ID - Type Unspecified