Healthcare Provider Details

I. General information

NPI: 1346243227
Provider Name (Legal Business Name): LANDIS HOMES RETIREMENT COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E OREGON RD
LITITZ PA
17543-9205
US

IV. Provider business mailing address

1001 E OREGON RD
LITITZ PA
17543-9205
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-3271
  • Fax: 717-581-3899
Mailing address:
  • Phone: 717-569-3271
  • Fax: 717-581-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1206
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0008383510002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MS. ETHEL CALDWELL
Title or Position: HEALTHCARE ADMINISTRATOR
Credential:
Phone: 717-381-3572