Healthcare Provider Details

I. General information

NPI: 1700881992
Provider Name (Legal Business Name): PRESBYTERIAN SENIORCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 HULTON RD
OAKMONT PA
15139-1135
US

IV. Provider business mailing address

1215 HULTON RD
OAKMONT PA
15139-1135
US

V. Phone/Fax

Practice location:
  • Phone: 412-826-6032
  • Fax: 412-826-6061
Mailing address:
  • Phone: 412-826-6032
  • Fax: 412-826-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberHP416587L
License Number StatePA

VIII. Authorized Official

Name: MR. ANDREW E. MANGENE
Title or Position: SR. VICE PRESIDENT/CFO
Credential:
Phone: 412-826-6081