Provider Demographics
NPI:1710971932
Name:PRESBYTERIAN HOMES IN THE PRESBYTERY OF HUNTINGDON
Entity Type:Organization
Organization Name:PRESBYTERIAN HOMES IN THE PRESBYTERY OF HUNTINGDON
Other - Org Name:PRESBYTERIAN HOME OF HOLLIDAYSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-502-8922
Mailing Address - Street 1:1 TRINITY DR E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-8522
Mailing Address - Country:US
Mailing Address - Phone:717-502-8840
Mailing Address - Fax:717-502-8842
Practice Address - Street 1:220 NEWRY ST
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-1626
Practice Address - Country:US
Practice Address - Phone:814-695-5095
Practice Address - Fax:717-737-6763
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-02
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA162302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007513140003Medicaid
PA395530Medicare ID - Type UnspecifiedHOLLIDAYSBURG MC