# 208 PENNKNOLL ROAD OPCO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pennknoll Village
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710795661
- **Authorized official:** TIFFANY HOBACK (MANAGER)
- **Authorized official phone:** (770) 698-9040

## Contact information

- **Practice address:** 208 PENNKNOLL RD, EVERETT, PA 15537-6940
- **Practice address phone:** (814) 623-3200
- **Practice address fax:** (814) 623-3202
- **Mailing address:** 208 PENNKNOLL RD, EVERETT, PA 15537-6940
- **Mailing address phone:** (814) 623-3200
- **Mailing address fax:** (814) 623-3202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 12/24/2024
- **Last updated:** 03/10/2025