MEDICARE: MORNINGSTAR SENIOR LIVING INC

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
1	310400000X	Assisted Living Facility	226280	PA
2	314000000X	Skilled Nursing Facility	392702	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669477261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORNINGSTAR SENIOR LIVING INC

Provider Business Mailing Address
First Line	:	175 W NORTH ST
Second Line	:
City	:	NAZARETH
State	:	PA
Zip	:	18064-1410
Country	:	US
Telephone Number	:	610-746-1000
Fax Number	:	610-746-1444

Provider Business Practice Location Address
First Line	:	175 W NORTH ST
Second Line	:
City	:	NAZARETH
State	:	PA
Zip	:	18064-1410
Country	:	US
Telephone Number	:	610-746-1000
Fax Number	:	610-746-1444

Authorized Official
Title or Position	:	SENIOR DIRECTOR & CONTROLLER
Name	:	ELIZABETH ANN WALDRON
Credential	:
Telephone Number	:	610-746-1007

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	10/12/2011

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