Provider Demographics
NPI:1346243227
Name:LANDIS HOMES RETIREMENT COMMUNITY
Entity Type:Organization
Organization Name:LANDIS HOMES RETIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-381-3572
Mailing Address - Street 1:1001 E OREGON RD
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9205
Mailing Address - Country:US
Mailing Address - Phone:717-569-3271
Mailing Address - Fax:717-581-3899
Practice Address - Street 1:1001 E OREGON RD
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9205
Practice Address - Country:US
Practice Address - Phone:717-569-3271
Practice Address - Fax:717-581-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1206314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008383510002Medicaid
PA395797Medicare ID - Type Unspecified