Provider Demographics
NPI:1225034440
Name:THE BRETHREN HOME COMMUNITY
Entity Type:Organization
Organization Name:THE BRETHREN HOME COMMUNITY
Other - Org Name:CROSS KEYS VILLAGE - THE BRETHREN HOME COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-624-5498
Mailing Address - Street 1:2990 CARLISLE PIKE
Mailing Address - Street 2:
Mailing Address - City:NEW OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:17350
Mailing Address - Country:US
Mailing Address - Phone:717-624-2161
Mailing Address - Fax:717-624-5252
Practice Address - Street 1:2990 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350-9582
Practice Address - Country:US
Practice Address - Phone:717-624-2161
Practice Address - Fax:717-624-5252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA022502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395108OtherCAPITAL BLUE CROSS
PA1007487670001Medicaid
PA0363OtherHIGHMARK BLUE SHIELD
PA0363OtherHIGHMARK BLUE SHIELD
PA395108OtherCAPITAL BLUE CROSS