Provider Demographics
NPI:1881691145
Name:KUTZTOWN MANOR, INC.
Entity type:Organization
Organization Name:KUTZTOWN MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MULROY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:610-630-2400
Mailing Address - Street 1:120 TREXLER AVE
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-9707
Mailing Address - Country:US
Mailing Address - Phone:610-683-6220
Mailing Address - Fax:610-683-6849
Practice Address - Street 1:120 TREXLER AVE
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-9707
Practice Address - Country:US
Practice Address - Phone:610-683-6220
Practice Address - Fax:610-683-6849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCORD HEALTH SERVICE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-01
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA111702314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009851970001Medicaid
PA20033735OtherAMERIHEALTH
PA39-5680Medicare ID - Type UnspecifiedMEDICARE