Healthcare Provider Details

I. General information

NPI: 1134177637
Provider Name (Legal Business Name): GUARDIAN ELDER CARE AT ALIQUIPPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 GOLF COURSE RD
ALIQUIPPA PA
15001-1110
US

IV. Provider business mailing address

8796 ROUTE 219
BROCKWAY PA
15824-6010
US

V. Phone/Fax

Practice location:
  • Phone: 724-375-0345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070702
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001860830-0001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MICHAEL EPERESI
Title or Position: CFO
Credential:
Phone: 814-265-1164