Provider Demographics
NPI:1154320950
Name:THE SHOOK HOME
Entity Type:Organization
Organization Name:THE SHOOK HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TRUHAN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA, MSW
Authorized Official - Phone:717-264-6815
Mailing Address - Street 1:55 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-2207
Mailing Address - Country:US
Mailing Address - Phone:717-264-6815
Mailing Address - Fax:717-264-0380
Practice Address - Street 1:55 S 2ND ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2207
Practice Address - Country:US
Practice Address - Phone:717-264-6815
Practice Address - Fax:717-264-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA100902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007552210001Medicaid
PA007552210001Medicaid