Healthcare Provider Details

I. General information

NPI: 1316610264
Provider Name (Legal Business Name): CHARIOT EBENSBURG SNF OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 MANOR DR
EBENSBURG PA
15931-4917
US

IV. Provider business mailing address

270 WALKER DR
STATE COLLEGE PA
16801-7097
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-8100
  • Fax:
Mailing address:
  • Phone: 814-277-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SHANA K MARK
Title or Position: DIR OF PROVIDER CONTRACTS
Credential: MBA
Phone: 814-277-4500