Provider Demographics
NPI:1508857897
Name:CORNWALL MANOR
Entity Type:Organization
Organization Name:CORNWALL MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-273-2647
Mailing Address - Street 1:1 BOYD STREET
Mailing Address - Street 2:P.O. BOX 125
Mailing Address - City:CORNWALL
Mailing Address - State:PA
Mailing Address - Zip Code:17016
Mailing Address - Country:US
Mailing Address - Phone:717-273-2647
Mailing Address - Fax:717-274-8090
Practice Address - Street 1:1 BOYD STREET
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:PA
Practice Address - Zip Code:17016
Practice Address - Country:US
Practice Address - Phone:717-273-2647
Practice Address - Fax:717-274-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395180Medicare ID - Type Unspecified