Healthcare Provider Details

I. General information

NPI: 1962433797
Provider Name (Legal Business Name): THE VILLAGE AT MORRISONS COVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 S MARKET ST
MARTINSBURG PA
16662-1005
US

IV. Provider business mailing address

429 S MARKET ST
MARTINSBURG PA
16662-1005
US

V. Phone/Fax

Practice location:
  • Phone: 814-793-2104
  • Fax: 814-793-3798
Mailing address:
  • Phone: 814-793-2104
  • Fax: 814-793-3798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number133702
License Number StatePA

VIII. Authorized Official

Name: MR. COREY I JONES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 814-793-2104