# WILLIAMSPORT HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336149129
- **Authorized official:** MR. DONALD S. POTE NHA (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (570) 323-8781

## Contact information

- **Practice address:** 1900 RAVINE RD, WILLIAMSPORT, PA 17701-1799
- **Practice address phone:** (570) 323-8781
- **Practice address fax:** (570) 323-4858
- **Mailing address:** 1900 RAVINE RD, WILLIAMSPORT, PA 17701-1799
- **Mailing address phone:** (570) 323-8781
- **Mailing address fax:** (570) 323-4858

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 491902 | PA | Yes |

## Other

- **Enumeration date:** 07/22/2005
- **Last updated:** 11/04/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0007492980001 | — | PA |
| 01 | — | 800632 | FIRST PRIORITY | — |