Provider Demographics
NPI:1033101803
Name:MARIA JOSEPH MANOR
Entity type:Organization
Organization Name:MARIA JOSEPH MANOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER MARGUERITE
Authorized Official - Middle Name:
Authorized Official - Last Name:HRUBY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA
Authorized Official - Phone:570-275-6100
Mailing Address - Street 1:875 MONTOUR BLVD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-9148
Mailing Address - Country:US
Mailing Address - Phone:570-275-4221
Mailing Address - Fax:570-275-5616
Practice Address - Street 1:600 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-7200
Practice Address - Country:US
Practice Address - Phone:570-275-6100
Practice Address - Fax:570-275-9057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA391302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100730379003Medicaid
PA395824Medicare ID - Type Unspecified