115 S Providence Road Operations LLC
NPI #1417667130 in Wallingford, Pennsylvania
Provider Information
- NPI Number
- 1417667130
- Entity Type
- Organization
- Organization Name
- 115 S Providence Road Operations LLC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- GENESIS PM PA OPERATIONS LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Dec 5, 2022
- Last Updated
- Jun 23, 2025
Practice Location
- Address
- 115 S PROVIDENCE RD
- City
- Wallingford
- State
- Pennsylvania
- ZIP Code
- 19086-6333
- Phone
- (610) 444-6350
Authorized Official
- Name
- MICHAEL T BERG
- Title
- SECRETARY
- Phone
- (505) 468-4742
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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