Provider Demographics
NPI:1457357683
Name:HOMEWOOD AT MARTINSBURG PA, INC.
Entity Type:Organization
Organization Name:HOMEWOOD AT MARTINSBURG PA, INC.
Other - Org Name:HOMEWOOD AT MARTINSBURG
Other - Org Type:Other Name
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-793-3728
Mailing Address - Street 1:437 GIVLER DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16662-1635
Mailing Address - Country:US
Mailing Address - Phone:814-793-3728
Mailing Address - Fax:814-793-3654
Practice Address - Street 1:437 GIVLER DRIVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:PA
Practice Address - Zip Code:16662-1605
Practice Address - Country:US
Practice Address - Phone:814-793-3728
Practice Address - Fax:814-793-3654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA340402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015682050002Medicaid
PA395896Medicare ID - Type UnspecifiedMEDICARE