115 S Providence Road Operations LLC
NPI 1417667130ActiveOrganization· Skilled Nursing Facility· Wallingford, PA
Skilled Nursing Facility in Wallingford, Pennsylvania, registered in NPPES in December 2022, part of Genesis Pm PA Operations LLC. The authorized official on file is Michael T. Berg, Secretary. Enrolled in Medicare as part a provider - skilled nursing facility.
Overview
| NPI | 1417667130 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Genesis Pm PA Operations LLC |
| NPI issued | Dec 5, 2022 |
| Last updated in NPPES | Jun 23, 2025 |
| Certified by provider | Jun 23, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Skilled Nursing Facility Primary | 314000000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part A Provider - Skilled Nursing Facility (PA) |
|---|
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