Provider Demographics
NPI:1962433797
Name:THE VILLAGE AT MORRISONS COVE
Entity type:Organization
Organization Name:THE VILLAGE AT MORRISONS COVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:I
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-793-2104
Mailing Address - Street 1:429 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16662-1005
Mailing Address - Country:US
Mailing Address - Phone:814-793-2104
Mailing Address - Fax:814-793-3798
Practice Address - Street 1:429 S MARKET ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:PA
Practice Address - Zip Code:16662-1005
Practice Address - Country:US
Practice Address - Phone:814-793-2104
Practice Address - Fax:814-793-3798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA133702314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0993OtherSECURITY BLUE
PA0007472200001Medicaid
PA1539402OtherUMWA
PA0007472200001Medicaid