Healthcare Provider Details

I. General information

NPI: 1235536038
Provider Name (Legal Business Name): OAK HRC HAVENCREST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 COUNTRY CLUB RD
MONONGAHELA PA
15063-1057
US

IV. Provider business mailing address

1277 COUNTRY CLUB RD
MONONGAHELA PA
15063-1057
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-3000
  • Fax:
Mailing address:
  • Phone: 724-258-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: HOWARD JAFFE
Title or Position: PRESIDENT
Credential:
Phone: 215-346-6454