Provider Demographics
NPI:1316945868
Name:REDSTONE PRESBYTERIAN SENIOR CARE
Entity type:Organization
Organization Name:REDSTONE PRESBYTERIAN SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT VP QUALITY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOUCKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN/BSN/NHA
Authorized Official - Phone:724-832-8400
Mailing Address - Street 1:6 GARDEN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-1351
Mailing Address - Country:US
Mailing Address - Phone:724-832-8400
Mailing Address - Fax:724-834-1724
Practice Address - Street 1:6 GARDEN CENTER DR
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1351
Practice Address - Country:US
Practice Address - Phone:724-832-8400
Practice Address - Fax:724-834-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA073202314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007575110001Medicaid
PA1122OtherHIGHMARK
PA396021Medicare ID - Type Unspecified