Provider Demographics
NPI:1699773655
Name:QUARRYVILLE PRESBYTERIAN RETIREMENT COMMUNITY
Entity type:Organization
Organization Name:QUARRYVILLE PRESBYTERIAN RETIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAYWARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:717-786-5202
Mailing Address - Street 1:625 ROBERT FULTON HWY
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-9202
Mailing Address - Country:US
Mailing Address - Phone:717-786-7321
Mailing Address - Fax:717-786-5288
Practice Address - Street 1:625 ROBERT FULTON HWY
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-9202
Practice Address - Country:US
Practice Address - Phone:717-786-7321
Practice Address - Fax:717-786-5288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA170102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA170102OtherDEPT OF HEALTH
PA0007496810002Medicaid
PA395336Medicare ID - Type Unspecified
PA0007496810002Medicaid