Provider Demographics
NPI:1750836813
Name:WALNUT HEALTH CARE LLC
Entity Type:Organization
Organization Name:WALNUT HEALTH CARE LLC
Other - Org Name:SHIPPENSBURG HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGAVOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-530-8300
Mailing Address - Street 1:121 WALNUT BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-8131
Mailing Address - Country:US
Mailing Address - Phone:717-530-8300
Mailing Address - Fax:717-530-8304
Practice Address - Street 1:121 WALNUT BOTTOM RD
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-8131
Practice Address - Country:US
Practice Address - Phone:717-530-8300
Practice Address - Fax:717-530-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility