1376541680 NPI number — HIGHLAND PARK CARE CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376541680 NPI number — HIGHLAND PARK CARE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLAND PARK CARE CENTER, LLC
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:
HIGHLAND PARK CARE 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:
1376541680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 SIGMA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15238-2826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-963-9150
Provider Business Mailing Address Fax Number:
412-963-6676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
745 N HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15206-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-362-6622
Provider Business Practice Location Address Fax Number:
412-362-5436
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HENNELL
Authorized Official First Name:
HERBERT
Authorized Official Middle Name:
H
Authorized Official Title or Position:
DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
412-963-9150

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  084902 , 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: 0018557400001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 247943 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000122136 . This is a "THREE RIVERS PROVIDER NO." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000122136 . This is a "MED PLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1439 . This is a "BLUE CROSS PROVIDER NO." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 226361 . This is a "ADVANTRA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1518391 . This is a "GATEWAY PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 226361 . This is a "HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 186730 . This is a "ADVANTRA PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: V0069A . This is a "UPMC PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 186730 . This is a "HEALTH AMERICA PROV. NO." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 226361 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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