Provider Demographics
NPI:1497824064
Name:ARBUTUS PARK MANOR
Entity type:Organization
Organization Name:ARBUTUS PARK MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:814-266-8621
Mailing Address - Street 1:207 OTTAWA STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2337
Mailing Address - Country:US
Mailing Address - Phone:814-266-8621
Mailing Address - Fax:814-266-5478
Practice Address - Street 1:207 OTTAWA STREET
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2337
Practice Address - Country:US
Practice Address - Phone:814-266-8621
Practice Address - Fax:814-266-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA012002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1328OtherBLUE CROSS BLUE SHIELD
PA0007549770001Medicaid
PA1328OtherBLUE CROSS BLUE SHIELD
PA4477220001Medicare NSC