Healthcare Provider Details

I. General information

NPI: 1275536476
Provider Name (Legal Business Name): VILLA ST JOSEPH OF BADEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 STATE STREET
BADEN PA
15005-1338
US

IV. Provider business mailing address

1030 STATE STREET
BADEN PA
15005-1338
US

V. Phone/Fax

Practice location:
  • Phone: 724-869-6300
  • Fax: 724-869-6399
Mailing address:
  • Phone: 724-869-6300
  • Fax: 724-869-6399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number069302
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0016442270002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MARY M MURRAY
Title or Position: ADMINISTRATOR
Credential: NHA, MPH
Phone: 724-869-6310