Provider Demographics
NPI:1609940014
Name:WILLOW VALLEY COMMUNITIES
Entity Type:Organization
Organization Name:WILLOW VALLEY COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF BOARD DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-464-2741
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:17584-9663
Mailing Address - Country:US
Mailing Address - Phone:717-464-2741
Mailing Address - Fax:717-464-0205
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:17584-9663
Practice Address - Country:US
Practice Address - Phone:717-464-6861
Practice Address - Fax:717-464-6898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396818Medicare Oscar/Certification