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General NPI Number Information
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NPI Number | 1245403302
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Entity Type | Organization
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Legal Business Name | SHAFFERS COUNTRYSIDE ASSISTED LIVING
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 1841 STOYSTOWN RD
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City | FRIEDENS
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State | PA
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Zip | 15541-7409
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Country | US
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Telephone | 814-444-1722
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Fax | 814-443-3879
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Provider Business Mailing Address
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Address Line | 1841 STOYSTOWN RD
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City | FRIEDENS
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State | PA
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Zip | 15541-7409
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Country | US
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Telephone | 814-444-1722
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Fax | 814-443-3879
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Authorized Official
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Title or Position | ADMINISTRATOR / OWNER
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Name | MRS. RUTH A SHAFFER
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Credential | RN
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Telephone | 814-444-1722
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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 | 321450
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License Number State | PA
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