Provider Demographics
NPI:1497757710
Name:SMNRC, LP
Entity Type:Organization
Organization Name:SMNRC, LP
Other - Org Name:SHENANDOAH MANOR NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLINGERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-784-0111
Mailing Address - Street 1:101 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:PA
Mailing Address - Zip Code:17976-1701
Mailing Address - Country:US
Mailing Address - Phone:570-462-1908
Mailing Address - Fax:570-462-1457
Practice Address - Street 1:101 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-1701
Practice Address - Country:US
Practice Address - Phone:570-462-1908
Practice Address - Fax:570-462-1457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA190102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395556Medicare Oscar/Certification