1518941657 NPI number — MOUNT MACRINA MANOR NURSING HOME

Table of content: (NPI 1184265100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518941657 NPI number — MOUNT MACRINA MANOR NURSING HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNT MACRINA MANOR NURSING HOME
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:
Provider Other Organization Name Type Code:
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:
1518941657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15401-2602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-437-1400
Provider Business Mailing Address Fax Number:
724-430-1095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15401-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-437-1400
Provider Business Practice Location Address Fax Number:
724-430-1095
Provider Enumeration Date:
12/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MEYERS
Authorized Official First Name:
JOLYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
724-430-1109

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  394102 , 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: 0007521120002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0577 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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