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General NPI Number Information
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NPI Number | 1154578326
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Entity Type | Organization
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Legal Business Name | 120 RIDER AVE PCH OPERATING CO
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 120 RIDER AVE
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City | LANCASTER
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State | PA
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Zip | 17603-4831
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Country | US
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Telephone | 717-397-3000
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Fax | 717-393-5742
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Provider Business Mailing Address
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Address Line | 120 RIDER AVE
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City | LANCASTER
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State | PA
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Zip | 17603-4831
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Country | US
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Telephone | 717-397-3000
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Fax | 717-393-5742
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BETH STORER
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Credential |
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Telephone | 717-397-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 328630
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License Number State | PA
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