Provider Demographics
NPI:1700870920
Name:MISERICORDIA CONVALESCENT HOME
Entity Type:Organization
Organization Name:MISERICORDIA CONVALESCENT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:BITTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-755-1964
Mailing Address - Street 1:998 S RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-3542
Mailing Address - Country:US
Mailing Address - Phone:717-755-1964
Mailing Address - Fax:717-840-0010
Practice Address - Street 1:998 S RUSSELL ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3542
Practice Address - Country:US
Practice Address - Phone:717-755-1964
Practice Address - Fax:717-840-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007479720001Medicaid
PA0007479720001Medicaid