Healthcare Provider Details

I. General information

NPI: 1326046699
Provider Name (Legal Business Name): LEBANON VALLEY BRETHREN HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 GRUBB RD
PALMYRA PA
17078-3514
US

IV. Provider business mailing address

1200 GRUBB RD
PALMYRA PA
17078-3514
US

V. Phone/Fax

Practice location:
  • Phone: 717-838-5406
  • Fax: 717-641-0073
Mailing address:
  • Phone: 717-838-5406
  • Fax: 717-641-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number380602
License Number StatePA

VIII. Authorized Official

Name: MR. DOUGLAS F GARRETT
Title or Position: CFO, VP FINANCE
Credential:
Phone: 717-838-5406