Provider Demographics
NPI:1194996355
Name:COVILLES PERSONAL CARE HOME
Entity type:Organization
Organization Name:COVILLES PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:COVILLE
Authorized Official - Suffix:II
Authorized Official - Credentials:RN
Authorized Official - Phone:724-583-9227
Mailing Address - Street 1:5 SOUTH 2ND ST.
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15461
Mailing Address - Country:US
Mailing Address - Phone:724-583-0744
Mailing Address - Fax:724-583-0350
Practice Address - Street 1:5 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15461-1538
Practice Address - Country:US
Practice Address - Phone:724-583-0744
Practice Address - Fax:724-583-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA424710311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home