Healthcare Provider Details

I. General information

NPI: 1942283528
Provider Name (Legal Business Name): COUNTY OF INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 SALTSBURG AVE
INDIANA PA
15701-3573
US

IV. Provider business mailing address

1675 SALTSBURG AVE
INDIANA PA
15701-3573
US

V. Phone/Fax

Practice location:
  • Phone: 724-465-3900
  • Fax: 724-465-2013
Mailing address:
  • Phone: 724-465-3900
  • Fax: 724-465-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number090102
License Number StatePA

VIII. Authorized Official

Name: MRS. KIMBERLY COBAUGH
Title or Position: ADMINISTRATOR
Credential: RNC, MSN, NHA
Phone: 724-465-3900