Healthcare Provider Details

I. General information

NPI: 1184629149
Provider Name (Legal Business Name): REBECCA RESIDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3746 CEDAR RIDGE RD
ALLISON PARK PA
15101-1048
US

IV. Provider business mailing address

3746 CEDAR RIDGE RD
ALLISON PARK PA
15101-1048
US

V. Phone/Fax

Practice location:
  • Phone: 724-444-0600
  • Fax: 724-444-6621
Mailing address:
  • Phone: 724-444-0600
  • Fax: 724-444-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number860102
License Number StatePA

VIII. Authorized Official

Name: MICHAEL KAUFMAN
Title or Position: NURSING HOME ADMINISTRATOR
Credential:
Phone: 724-444-0600