Provider Demographics
NPI:1265504369
Name:GROVE MANOR CORPORATION
Entity Type:Organization
Organization Name:GROVE MANOR CORPORATION
Other - Org Name:GROVE MANOR CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:NOTARFRANCISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-266-2852
Mailing Address - Street 1:435 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1711
Mailing Address - Country:US
Mailing Address - Phone:856-266-2852
Mailing Address - Fax:414-908-7105
Practice Address - Street 1:435 N BROAD ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1711
Practice Address - Country:US
Practice Address - Phone:724-958-7800
Practice Address - Fax:724-458-6122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100750943Medicaid
PA100750943Medicaid