Provider Demographics
NPI:1497750053
Name:GARVEY MANOR NURSING HOME
Entity Type:Organization
Organization Name:GARVEY MANOR NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SR. JOACHIM ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERENCHAK, O. CARM.
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:814-695-5571
Mailing Address - Street 1:1037 SOUTH LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-2604
Mailing Address - Country:US
Mailing Address - Phone:814-695-5571
Mailing Address - Fax:814-695-8516
Practice Address - Street 1:1037 SOUTH LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-2604
Practice Address - Country:US
Practice Address - Phone:814-695-5571
Practice Address - Fax:814-695-8516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA316410311ZA0620X
PA070202313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0612OtherHIGHMARK BC / BS
PA0007483430002Medicaid
PA0612OtherHIGHMARK BC / BS