# RIDDLE VILLAGE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Monticello House
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679570196
- **Authorized official:** MRS. KIM ROGUSZEUSKI (CFO/VICE PRESIDENT)
- **Authorized official phone:** (610) 891-3783

## Contact information

- **Practice address:** 1048 W BALTIMORE PIKE, MEDIA, PA 19063-5149
- **Practice address phone:** (610) 891-3806
- **Practice address fax:** (610) 891-3829
- **Mailing address:** 1048 W BALTIMORE PIKE, MEDIA, PA 19063-5149
- **Mailing address phone:** (610) 891-3806
- **Mailing address fax:** (610) 891-3829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 017302 | PA | Yes |

## Other

- **Enumeration date:** 06/30/2005
- **Last updated:** 10/27/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1451 | INDEPENDENCE BLUE CROSS | PA |
| 01 | — | 391335 | HIGHMARK BLUE CROSS | PA |
| 01 | — | 576790 | AETNA/US HEALTHCARE | PA |