Provider Demographics
NPI:1699840645
Name:RESIDENCE FOR RENAL CARE AT SHADYSIDE, LTD
Entity type:Organization
Organization Name:RESIDENCE FOR RENAL CARE AT SHADYSIDE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:NEALON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-661-1740
Mailing Address - Street 1:5511 BAUM BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1203
Mailing Address - Country:US
Mailing Address - Phone:412-661-1740
Mailing Address - Fax:412-661-7688
Practice Address - Street 1:5511 BAUM BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1203
Practice Address - Country:US
Practice Address - Phone:412-661-1740
Practice Address - Fax:412-661-7688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395789Medicare Oscar/Certification