Provider Demographics
NPI:1518965946
Name:WHITE HORSE VILLAGE INC.
Entity Type:Organization
Organization Name:WHITE HORSE VILLAGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:610-558-5799
Mailing Address - Street 1:535 GRADYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2815
Mailing Address - Country:US
Mailing Address - Phone:610-558-5799
Mailing Address - Fax:610-558-5001
Practice Address - Street 1:535 GRADYVILLE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2815
Practice Address - Country:US
Practice Address - Phone:610-558-5799
Practice Address - Fax:610-558-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA179430310400000X
PA235902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395833Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER