Provider Demographics
NPI:1811993116
Name:HOMEWOOD LIVING WILLIAMSPORT, INC.
Entity type:Organization
Organization Name:HOMEWOOD LIVING WILLIAMSPORT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-582-1628
Mailing Address - Street 1:16505 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21795-1321
Mailing Address - Country:US
Mailing Address - Phone:301-582-1628
Mailing Address - Fax:301-582-1815
Practice Address - Street 1:16505 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:MD
Practice Address - Zip Code:21795-1321
Practice Address - Country:US
Practice Address - Phone:301-582-1628
Practice Address - Fax:301-582-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
MD21008314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21D0649913OtherCLIA
MD217447200Medicaid