MEDICARE: BARR STREET CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	035702	PA
2	314000000X	Skilled Nursing Facility	035702	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0581	OTHER	PA	HIGHMARK BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275536880
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARR STREET CORPORATION

Provider Business Mailing Address
First Line	:	300 BARR ST
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317
Country	:	US
Telephone Number	:	724-746-5040
Fax Number	:	724-873-9074

Provider Business Practice Location Address
First Line	:	300 BARR ST
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317
Country	:	US
Telephone Number	:	724-746-5040
Fax Number	:	724-873-9074

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. BENJAMIN KATSEVICH
Credential	:	NHA RN
Telephone Number	:	724-746-5040

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	12/20/2011

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Directions to “BARR STREET CORPORATION ” Practice Location

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