Healthcare Provider Details

I. General information

NPI: 1467478941
Provider Name (Legal Business Name): STONERIDGE RETIREMENT LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 W PARK AVE
MYERSTOWN PA
17067-1340
US

IV. Provider business mailing address

7 W PARK AVE
MYERSTOWN PA
17067-1340
US

V. Phone/Fax

Practice location:
  • Phone: 717-866-6541
  • Fax: 717-866-6448
Mailing address:
  • Phone: 717-866-6541
  • Fax: 717-866-6448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number051102
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierMA1007512800002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. STEVEN J REITER
Title or Position: PRESIDENT CEO
Credential:
Phone: 717-866-3200