# ARBUTUS PARK MANOR

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

## Provider details

- **NPI number:** 1497824064
- **Authorized official:** RICHARD W WILSON NHA (ADMINSTRATOR)
- **Authorized official phone:** (814) 266-8621

## Contact information

- **Practice address:** 207 OTTAWA STREET, JOHNSTOWN, PA 15904-2337
- **Practice address phone:** (814) 266-8621
- **Practice address fax:** (814) 266-5478
- **Mailing address:** 207 OTTAWA STREET, JOHNSTOWN, PA 15904-2337
- **Mailing address phone:** (814) 266-8621
- **Mailing address fax:** (814) 266-5478

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 012002 | PA | Yes |

## Other

- **Enumeration date:** 11/07/2006
- **Last updated:** 11/29/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0007549770001 | — | PA |
| 01 | — | 1328 | BLUE CROSS BLUE SHIELD | PA |