Organization
69 COTTAGE ROAD OPCO LLC
Active
Other names
Locust Grove Retirement Village
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY HOBACK (MANAGER)
(770) 698-9040
Entity
Organization
Contact information
Practice address
69 COTTAGE RD, MIFFLIN, PA 17058-7030
(717) 436-8921
(717) 436-9165
Mailing address
69 COTTAGE RD, MIFFLIN, PA 17058-7030
(717) 436-8921
(717) 436-9165
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
12/23/2024
Last updated
03/10/2025
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