Healthcare Provider Details

I. General information

NPI: 1598137572
Provider Name (Legal Business Name): REHABILITATION CENTER AT BRETHREN VILLAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 LITITZ PIKE
LITITZ PA
17543-9414
US

IV. Provider business mailing address

3001 LITITZ PIKE
LITITZ PA
17543-9414
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-2657
  • Fax: 717-581-4402
Mailing address:
  • Phone: 717-569-2657
  • Fax: 717-581-4402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: RODNEY L MARTZALL
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 717-581-4234