Healthcare Provider Details

I. General information

NPI: 1508484502
Provider Name (Legal Business Name): TIMBER RIDGE SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 EAST END BOULEVARD
PLAINS TWP PA
18702-7927
US

IV. Provider business mailing address

1555 EAST END BOULEVARD
PLAINS TWP PA
18702-7927
US

V. Phone/Fax

Practice location:
  • Phone: 570-826-1011
  • Fax: 570-825-1211
Mailing address:
  • Phone: 570-826-1011
  • Fax: 570-825-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. CHAIM STEG
Title or Position: OWNER
Credential:
Phone: 732-267-9679