Basic Information
| Provider Information | |||||||||
| NPI: | 1265504369 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GROVE MANOR CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GROVE MANOR CORPORATION | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 N BROAD ST | ||||||||
| Address2: | |||||||||
| City: | GROVE CITY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161271711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562662852 | ||||||||
| FaxNumber: | 4149087105 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 N BROAD ST | ||||||||
| Address2: | |||||||||
| City: | GROVE CITY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161271711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249587800 | ||||||||
| FaxNumber: | 7244586122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 07/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | NOTARFRANCISCO | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
| AuthorizedOfficialMiddleName: | KAY | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8562662852 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 100750943 | 05 | PA | MEDICAID |