Organization
WILLIAMSPORT HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD S. POTE NHA (EXECUTIVE DIRECTOR)
(570) 323-8781
Entity
Organization
Contact information
Practice address
1900 RAVINE RD, WILLIAMSPORT, PA 17701-1799
(570) 323-8781
(570) 323-4858
Mailing address
1900 RAVINE RD, WILLIAMSPORT, PA 17701-1799
(570) 323-8781
(570) 323-4858
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
491902
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007492980001
—
PA
01
—
800632
FIRST PRIORITY
—
Enumeration date
07/22/2005
Last updated
11/04/2011
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