Provider Demographics
NPI:1164633285
Name:SUSANS VICTORIAN COTTAGE
Entity Type:Organization
Organization Name:SUSANS VICTORIAN COTTAGE
Other - Org Name:VICTORIAN COTTAGE PERSONAL CARE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:724-423-8706
Mailing Address - Street 1:RR 5 BOX 64E (OLD ADDRESS BEFORE IT CHANGED)
Mailing Address - Street 2:111 HYDRANGEA LANE (NEW 911 EMS ADDRESS)
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-3648
Mailing Address - Country:US
Mailing Address - Phone:724-424-8706
Mailing Address - Fax:724-423-6238
Practice Address - Street 1:111 HYDRANGEA LANE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-3648
Practice Address - Country:US
Practice Address - Phone:724-424-8706
Practice Address - Fax:724-423-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA001030310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility