Healthcare Provider Details

I. General information

NPI: 1356331235
Provider Name (Legal Business Name): COUNTY OF ALLEGHENY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 9TH ST
MCKEESPORT PA
15132-3952
US

IV. Provider business mailing address

955 RIVERMONT DR ATTN: CHIEF FISCAL OFFICER
PITTSBURGH PA
15207-1347
US

V. Phone/Fax

Practice location:
  • Phone: 412-422-6050
  • Fax: 412-422-6966
Mailing address:
  • Phone: 412-422-6050
  • Fax: 412-422-6966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number364702
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1007463050048
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1007411200008
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DAVID C POLINAK
Title or Position: CFO
Credential:
Phone: 412-422-6050