1841290731 NPI number — COUNTRY MEADOWS OF SOUTH HILLS ASSOCIATES

Table of content: (NPI 1841290731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841290731 NPI number — COUNTRY MEADOWS OF SOUTH HILLS ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTRY MEADOWS OF SOUTH HILLS ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTH HILLS NURSING AND REHABILITIATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841290731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
830 CHERRY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033-2007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-533-0723
Provider Business Mailing Address Fax Number:
717-533-1014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3590 WASHINGTON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15017-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-257-2474
Provider Business Practice Location Address Fax Number:
412-257-0358
Provider Enumeration Date:
07/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MIZAK
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
VP- FINANCE, ACCOUNTING, INFO SRVS
Authorized Official Telephone Number:
717-533-0723

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  125402 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0009828380001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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