Provider Demographics
NPI:1134123730
Name:CATHEDRAL VILLAGE
Entity Type:Organization
Organization Name:CATHEDRAL VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-502-8922
Mailing Address - Street 1:1 TRINITY DR E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-8522
Mailing Address - Country:US
Mailing Address - Phone:717-502-8840
Mailing Address - Fax:717-502-8842
Practice Address - Street 1:600 E CATHEDRAL RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1933
Practice Address - Country:US
Practice Address - Phone:215-487-1330
Practice Address - Fax:215-984-8689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA030402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0757549Medicaid
PA395467Medicare Oscar/Certification
PA0757549Medicaid