Provider Demographics
NPI:1740287499
Name:GUY AND MARY FELT MANOR, INC.
Entity type:Organization
Organization Name:GUY AND MARY FELT MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:814-486-3736
Mailing Address - Street 1:110 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIUM
Mailing Address - State:PA
Mailing Address - Zip Code:15834-1445
Mailing Address - Country:US
Mailing Address - Phone:814-486-3736
Mailing Address - Fax:814-486-3827
Practice Address - Street 1:110 E 4TH ST
Practice Address - Street 2:
Practice Address - City:EMPORIUM
Practice Address - State:PA
Practice Address - Zip Code:15834-1445
Practice Address - Country:US
Practice Address - Phone:814-486-3736
Practice Address - Fax:814-486-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA75018441314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA606OtherBLUE CROSS
PA0007521030001Medicaid
PA0007521030001Medicaid