Organization
RIDDLE VILLAGE
Active
Other names
Monticello House
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM ROGUSZEUSKI (CFO/VICE PRESIDENT)
(610) 891-3783
Entity
Organization
Contact information
Practice address
1048 W BALTIMORE PIKE, MEDIA, PA 19063-5149
(610) 891-3806
(610) 891-3829
Mailing address
1048 W BALTIMORE PIKE, MEDIA, PA 19063-5149
(610) 891-3806
(610) 891-3829
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
017302
PA
Other
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
Enumeration date
06/30/2005
Last updated
10/27/2023
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