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General NPI Number Information
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NPI Number | 1033529490
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Entity Type | Organization
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Legal Business Name | BUFFALO VALLEY LUTHERAN VILLAGE
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 189 E TRESSLER BLVD
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City | LEWISBURG
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State | PA
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Zip | 17837-9272
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Country | US
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Telephone | 570-523-4226
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Fax |
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Provider Business Mailing Address
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Address Line | 131 FOREST HILL RD
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City | MIFFLINBURG
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State | PA
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Zip | 17844-7004
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Country | US
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Telephone | 570-412-5064
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THREAPY ASSISTANT
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Name | MRS. TRACI LYNN KLINE
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Credential | OTA
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Telephone | 570-523-4226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | OP006155
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License Number State | PA
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