Healthcare Provider Details

I. General information

NPI: 1629074935
Provider Name (Legal Business Name): VINCENTIAN HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 PERRYMONT RD
PITTSBURGH PA
15237-5239
US

IV. Provider business mailing address

8250 BABCOCK BLVD
PITTSBURGH PA
15237-5825
US

V. Phone/Fax

Practice location:
  • Phone: 412-366-5600
  • Fax: 412-366-1408
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: SISTER ANNE KULL
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 412-366-5600