Healthcare Provider Details

I. General information

NPI: 1063504645
Provider Name (Legal Business Name): SUGARCREEK STATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 CAUSEWAY DR
FRANKLIN PA
16323-5523
US

IV. Provider business mailing address

200 LOTHROP ST STE 10097
PITTSBURGH PA
15213-2536
US

V. Phone/Fax

Practice location:
  • Phone: 814-437-0100
  • Fax: 814-437-1337
Mailing address:
  • Phone: 412-864-3532
  • Fax: 412-864-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number220602
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1000014030004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: WILLIAM ANTHONY NIGRO
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 412-864-3532