Provider Demographics
NPI:1396748455
Name:ALLEGHENY HOME HEALTH, INC.
Entity type:Organization
Organization Name:ALLEGHENY HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-471-2877
Mailing Address - Street 1:1100 W HIGH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1706
Mailing Address - Country:US
Mailing Address - Phone:814-471-2877
Mailing Address - Fax:814-471-2876
Practice Address - Street 1:1100 W HIGH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1706
Practice Address - Country:US
Practice Address - Phone:814-471-2877
Practice Address - Fax:814-471-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA742705251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009041910001OtherPDAWAIVER PROVIDER NUMBER
PA850OtherHIGHMARK BLUE CROSS PROVI
PA01026576Medicaid
PA397427Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER