MEDICARE: WILLOW VALLEY COMMUNITIES

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	314000000X	Skilled Nursing Facility	233602	PA

General Provider Information

NPI Number	:	1740351584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW VALLEY COMMUNITIES

Provider Business Mailing Address
First Line	:	300 WILLOW VALLEY LAKES DR
Second Line	:
City	:	WILLOW STREET
State	:	PA
Zip	:	17584-9442
Country	:	US
Telephone Number	:	717-464-6129
Fax Number	:	717-464-6034

Provider Business Practice Location Address
First Line	:	300 WILLOW VALLEY LAKES DR
Second Line	:
City	:	WILLOW STREET
State	:	PA
Zip	:	17584-9442
Country	:	US
Telephone Number	:	717-464-9542
Fax Number	:	717-464-1913

Authorized Official
Title or Position	:	PRESIDENT OF BOARD OF DIRECTORS
Name	:	MR. JAMES HOSTETTER
Credential	:
Telephone Number	:	717-464-2741

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	03/30/2015

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