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General NPI Number Information
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NPI Number | 1689633943
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Entity Type | Organization
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Legal Business Name | SUSQUEHANNA VALLEY NURSING AND REHABILITATION CENTER LLC
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 745 CHIQUES HILL ROAD
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City | COLUMBIA
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State | PA
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Zip | 17512-8411
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Country | US
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Telephone | 717-684-7555
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Fax | 717-684-3677
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Provider Business Mailing Address
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Address Line | 745 CHIQUES HILL RD
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City | COLUMBIA
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State | PA
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Zip | 17512-8411
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Country | US
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Telephone | 717-684-7555
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Fax | 717-684-3677
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Authorized Official
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Title or Position | NURSING HOME ADMINISTRATOR
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Name | MR. STEPHEN L. DIFFENDERFER
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Credential | NHA
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Telephone | 717-684-7555
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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 | 084802
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License Number State | PA
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