Provider Demographics
NPI:1215489745
Name:PASSAVANT MEMORIAL HOMES
Entity type:Organization
Organization Name:PASSAVANT MEMORIAL HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UTILIZATION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-820-1010
Mailing Address - Street 1:100 PASSAVANT WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-1318
Mailing Address - Country:US
Mailing Address - Phone:412-820-1010
Mailing Address - Fax:412-820-9246
Practice Address - Street 1:2550 EISENHOWER AVEUNE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19403-2331
Practice Address - Country:US
Practice Address - Phone:412-820-1010
Practice Address - Fax:412-820-9246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X, 164W00000X
PA439240251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100001216OtherMASTER PROVIDER INDEX