Provider Demographics
NPI:1831180173
Name:PENNSWOOD VILLAGE
Entity type:Organization
Organization Name:PENNSWOOD VILLAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA
Authorized Official - Phone:215-504-1157
Mailing Address - Street 1:1382 NEWTOWN LANGHORNE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-2401
Mailing Address - Country:US
Mailing Address - Phone:215-968-9110
Mailing Address - Fax:215-504-1133
Practice Address - Street 1:1382 NEWTOWN LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-2401
Practice Address - Country:US
Practice Address - Phone:215-968-9110
Practice Address - Fax:215-504-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA144520310400000X
PA164002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA557986Medicare UPIN
PAB37653Medicare UPIN
PAS61718Medicare UPIN
PAB42226Medicare UPIN
PAP44431Medicare UPIN
PA39-5473Medicare ID - Type UnspecifiedPROVIDER NUMBER