Healthcare Provider Details

I. General information

NPI: 1487655809
Provider Name (Legal Business Name): WRC PENNSYLVANIA MEMORIAL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 LAURELBROOKE DR
BROOKVILLE PA
15825-2653
US

IV. Provider business mailing address

985 ROUTE 28
BROOKVILLE PA
15825-7213
US

V. Phone/Fax

Practice location:
  • Phone: 814-849-3615
  • Fax: 814-849-4913
Mailing address:
  • Phone: 814-849-1205
  • Fax: 814-849-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number421402
License Number StatePA

VIII. Authorized Official

Name: MRS. SUSAN M SCHMADER
Title or Position: CFO
Credential:
Phone: 814-849-1205