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NPI Code Detail

MEDICARE: 200 PAULINE DRIVE OPERATIONS LLC

MEDICARE: 200 PAULINE DRIVE OPERATIONS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1326758046
Entity Type Code : Organization
Provider Name (Legal Business Name) : 200 PAULINE DRIVE OPERATIONS LLC
Provider Business Mailing Address
First Line : 101 E STATE ST
Second Line :
City : KENNETT SQUARE
State : PA
Zip : 19348-3109
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 200 PAULINE DR
Second Line :
City : YORK
State : PA
Zip : 17402-4625
Country : US
Telephone Number : 610-444-6350
Fax Number :
Authorized Official
Title or Position : ASST SECRETARY
Name : MICHAEL T BERG
Credential :
Telephone Number : 505-468-4742
Provider Enumeration Date : 12/05/2022
Last Update Date : 01/06/2023

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