1770571341 NPI number — ST. BARNABAS NURSING HOME, INC.

Table of content: (NPI 1770571341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770571341 NPI number — ST. BARNABAS NURSING HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. BARNABAS NURSING HOME, INC.
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:
1770571341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5827 MERIDIAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIBSONIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15044-9404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-443-0700
Provider Business Mailing Address Fax Number:
724-443-5611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5827 MERIDIAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIBSONIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15044-9404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-443-0700
Provider Business Practice Location Address Fax Number:
724-443-5611
Provider Enumeration Date:
10/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JENKINS
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
724-443-0700

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1012019460001 , 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: 1012019460001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: S7953 . This is a "BC OF MICHIGAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0549 . This is a "BLUE CROSS SEC BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 96453 . This is a "MEDPLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com