Provider Demographics
NPI:1609250174
Name:MEADOW RIDGE
Entity Type:Organization
Organization Name:MEADOW RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL CARE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LENORE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-464-6816
Mailing Address - Street 1:900 WILLOW VALLEY LAKES DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-9051
Mailing Address - Country:US
Mailing Address - Phone:717-464-6816
Mailing Address - Fax:717-490-8110
Practice Address - Street 1:900 WILLOW VALLEY LAKES DR
Practice Address - Street 2:
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584-9051
Practice Address - Country:US
Practice Address - Phone:717-464-6816
Practice Address - Fax:717-490-8110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA322050311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home