Healthcare Provider Details

I. General information

NPI: 1003166802
Provider Name (Legal Business Name): SENIOR LIFE GREENSBURG, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 TRIANGLE DRIVE
GREENSBURG PA
15601-3510
US

IV. Provider business mailing address

209 SIGMA DR
PITTSBURGH PA
15238-2826
US

V. Phone/Fax

Practice location:
  • Phone: 724-838-8300
  • Fax:
Mailing address:
  • Phone: 412-963-9150
  • Fax: 412-963-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number075064
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. HERBERT H HENNELL
Title or Position: DIR. OF REIMBURSEMENT
Credential:
Phone: 412-963-9150