Provider Demographics
NPI:1295735157
Name:WILMAC HEALTHCARE, INC.
Entity type:Organization
Organization Name:WILMAC HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-854-7857
Mailing Address - Street 1:2829 LITITZ PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3321
Mailing Address - Country:US
Mailing Address - Phone:717-569-3211
Mailing Address - Fax:717-569-1569
Practice Address - Street 1:2829 LITITZ PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3321
Practice Address - Country:US
Practice Address - Phone:717-569-3211
Practice Address - Fax:717-569-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA120302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0756926Medicaid
PW395205Medicare Oscar/Certification