Provider Demographics
NPI:1689633943
Name:SUSQUEHANNA VALLEY NURSING AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:SUSQUEHANNA VALLEY NURSING AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIFFENDERFER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:717-684-7555
Mailing Address - Street 1:745 CHIQUES HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-8411
Mailing Address - Country:US
Mailing Address - Phone:717-684-7555
Mailing Address - Fax:717-684-3677
Practice Address - Street 1:745 CHIQUES HILL ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-8411
Practice Address - Country:US
Practice Address - Phone:717-684-7555
Practice Address - Fax:717-684-3677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA084802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11011465300001Medicaid
PA1011465300001Medicaid
PA1011465300001Medicaid