OrganizationActive
115 S Providence Road Operations LLC
NPI 1417667130 · Skilled Nursing Facility · Wallingford, PA
Provider details
- NPI number
- 1417667130
- Entity type
- Organization
- Primary specialty
- Skilled Nursing FacilityNursing & Custodial Care Facilities
- Parent organization
- Genesis Pm PA Operations LLC
- Authorized official
- Michael Berg, Secretary
Practice location
115 S Providence Rd
Wallingford, PA 19086-6333
Phone: (610) 444-6350
Mailing address
101 E State St
Kennett Square, PA 19348-3109
Registry dates
- Enumerated
- 2022-12-05
- Last updated
- 2025-06-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.