Healthcare Provider Details

I. General information

NPI: 1043216351
Provider Name (Legal Business Name): CENTRE CREST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E HOWARD ST
BELLEFONTE PA
16823
US

IV. Provider business mailing address

502 E HOWARD ST
BELLEFONTE PA
16823
US

V. Phone/Fax

Practice location:
  • Phone: 814-355-6777
  • Fax: 814-355-6999
Mailing address:
  • Phone: 814-355-6777
  • Fax: 814-355-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031702
License Number StatePA

VIII. Authorized Official

Name: MR. RICHARD J BRUNO
Title or Position: ADMINISTRATOR
Credential:
Phone: 814-355-6777