Provider Demographics
NPI:1467478941
Name:STONERIDGE RETIREMENT LIVING
Entity Type:Organization
Organization Name:STONERIDGE RETIREMENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-866-3200
Mailing Address - Street 1:7 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-1340
Mailing Address - Country:US
Mailing Address - Phone:717-866-6541
Mailing Address - Fax:717-866-6448
Practice Address - Street 1:7 W PARK AVE
Practice Address - Street 2:
Practice Address - City:MYERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17067-1340
Practice Address - Country:US
Practice Address - Phone:717-866-6541
Practice Address - Fax:717-866-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA051102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA1007512800002Medicaid
PAMA1007512800002Medicaid