1104840735 NPI number — RETIREMENT VILLAGE OF NORTH STRABANE FACILITY OPERATIONS, LLC

Table of content: (NPI 1104840735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104840735 NPI number — RETIREMENT VILLAGE OF NORTH STRABANE FACILITY OPERATIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RETIREMENT VILLAGE OF NORTH STRABANE FACILITY OPERATIONS, LLC
Provider Last Name:
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Provider Middle Name:
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Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1104840735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 CONCOURSE PKWY S
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MAITLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32751-6148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-571-1550
Provider Business Mailing Address Fax Number:
407-571-1599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 TANDEM VILLAGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANONSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15317-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-746-0600
Provider Business Practice Location Address Fax Number:
724-743-1103
Provider Enumeration Date:
07/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CONTE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
407-571-1550

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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