Provider Demographics
NPI:1194758151
Name:WILLOW VALLEY COMMUNITIES
Entity type:Organization
Organization Name:WILLOW VALLEY COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-464-2741
Mailing Address - Street 1:675 WILLOW VALLEY SQ
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4876
Mailing Address - Country:US
Mailing Address - Phone:717-464-2741
Mailing Address - Fax:717-464-0205
Practice Address - Street 1:675 WILLOW VALLEY SQ
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4876
Practice Address - Country:US
Practice Address - Phone:717-464-6130
Practice Address - Fax:717-464-6132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA077902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
395956Medicare ID - Type Unspecified