Healthcare Provider Details

I. General information

NPI: 1588660906
Provider Name (Legal Business Name): VINCENTIAN DE MARILLAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 STANTON AVE
PITTSBURGH PA
15206-2083
US

IV. Provider business mailing address

8250 BABCOCK BLVD
PITTSBURGH PA
15237-5825
US

V. Phone/Fax

Practice location:
  • Phone: 412-361-2833
  • Fax: 412-361-2833
Mailing address:
  • Phone: 412-548-4073
  • Fax: 412-348-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JESSICA KLINE
Title or Position: FINANCE
Credential:
Phone: 412-548-4073