Healthcare Provider Details

I. General information

NPI: 1730415670
Provider Name (Legal Business Name): MEADVILLE REHABILITATION & NURSING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14714 PARK AVENUE EXT
MEADVILLE PA
16335-9400
US

IV. Provider business mailing address

4597 ROUTE 9 N
HOWELL NJ
07731-3382
US

V. Phone/Fax

Practice location:
  • Phone: 814-337-4228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number131702
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: NATHAN STERN
Title or Position: AUTHORIZED MEMBER
Credential:
Phone: 732-942-1344