Provider Demographics
NPI:1962409060
Name:ALTOONA CENTER FOR NURSING CARE, LLC
Entity type:Organization
Organization Name:ALTOONA CENTER FOR NURSING CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:HENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-963-9150
Mailing Address - Street 1:1020 GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4623
Mailing Address - Country:US
Mailing Address - Phone:814-946-2700
Mailing Address - Fax:814-946-4108
Practice Address - Street 1:1020 GREEN AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4623
Practice Address - Country:US
Practice Address - Phone:814-946-2700
Practice Address - Fax:814-946-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA065402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019284080001Medicaid
PA1817OtherHIGHMARK BLUE CROSS
PA318492OtherUPMC
PA1027428OtherGATEWAY
PA000000138587OtherUNISON
PA1517551OtherUMWA
PA1817OtherSECURITY BLUE
PA000000138587OtherUNISON