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General NPI Number Information
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NPI Number | 1336149129
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Entity Type | Organization
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Legal Business Name | WILLIAMSPORT HOME
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 1900 RAVINE RD
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1799
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Country | US
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Telephone | 570-323-8781
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Fax | 570-323-4858
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Provider Business Mailing Address
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Address Line | 1900 RAVINE RD
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1799
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Country | US
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Telephone | 570-323-8781
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Fax | 570-323-4858
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DONALD S. POTE
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Credential | NHA
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Telephone | 570-323-8781
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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 | 491902
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License Number State | PA
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