Healthcare Provider Details

I. General information

NPI: 1235168519
Provider Name (Legal Business Name): WILLIAM PENN CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ADER RD
JEANNETTE PA
15644-4500
US

IV. Provider business mailing address

2020 ADER RD
JEANNETTE PA
15644-4500
US

V. Phone/Fax

Practice location:
  • Phone: 724-327-3500
  • Fax: 724-327-7320
Mailing address:
  • Phone: 724-327-3500
  • Fax: 724-327-7320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number312402
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1001679750002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: BRITTANY WUKICH
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 724-327-3500