Provider Demographics
NPI:1225861537
Name:PUNXSUTAWNEY PA OPCO LLC
Entity type:Organization
Organization Name:PUNXSUTAWNEY PA OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-521-0490
Mailing Address - Street 1:411 W MAHONING STREET
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767
Mailing Address - Country:US
Mailing Address - Phone:814-938-6020
Mailing Address - Fax:
Practice Address - Street 1:411 W MAHONING STREET
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767
Practice Address - Country:US
Practice Address - Phone:814-938-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility