1184869877 NPI number — NUGENT CONVALESCENT HOME, INC.

Table of content: (NPI 1184869877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184869877 NPI number — NUGENT CONVALESCENT HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUGENT CONVALESCENT 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:
1184869877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 CLARKSVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERMITAGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16148-2954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-981-6610
Provider Business Mailing Address Fax Number:
724-981-3224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 CLARKSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16148-2954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-981-6610
Provider Business Practice Location Address Fax Number:
724-981-3224
Provider Enumeration Date:
12/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FREED
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
724-981-6610

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  140702 , 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: 1022367860001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com