Provider Demographics
NPI:1912907841
Name:WILMAC HEALTHCARE, INC.
Entity Type:Organization
Organization Name:WILMAC HEALTHCARE, INC.
Other - Org Name:COLONIAL MANOR NURSING & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-854-7857
Mailing Address - Street 1:970 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3430
Mailing Address - Country:US
Mailing Address - Phone:717-845-2661
Mailing Address - Fax:717-854-0529
Practice Address - Street 1:970 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3430
Practice Address - Country:US
Practice Address - Phone:717-845-2661
Practice Address - Fax:717-854-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2006635OtherAMERIHEALTH
PA01027036Medicaid
PA395168OtherKEYSTONE
PA2006635OtherAMERIHEALTH