Provider Demographics
NPI:1760068381
Name:WILLIAMSPORT SOUTH OPERATIONS LLC
Entity Type:Organization
Organization Name:WILLIAMSPORT SOUTH OPERATIONS LLC
Other - Org Name:WILLIAMSPORT SOUTH REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-912-2700
Mailing Address - Street 1:101 LEADER DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1942
Mailing Address - Country:US
Mailing Address - Phone:570-323-3758
Mailing Address - Fax:570-323-9228
Practice Address - Street 1:101 LEADER DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1942
Practice Address - Country:US
Practice Address - Phone:570-323-3758
Practice Address - Fax:570-323-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103891927-0001Medicaid