Healthcare Provider Details

I. General information

NPI: 1164485777
Provider Name (Legal Business Name): OSPTA HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 STATE ROUTE 51
ROSTRAVER TOWNSHIP PA
15012-3535
US

IV. Provider business mailing address

4325 STATE ROUTE 51
ROSTRAVER TOWNSHIP PA
15012-3535
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-4859
  • Fax: 724-483-4793
Mailing address:
  • Phone: 724-483-4859
  • Fax: 724-483-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number02170501
License Number StatePA

VIII. Authorized Official

Name: JENNIFER LEE POPELAS
Title or Position: BILLING MANAGER
Credential:
Phone: 724-565-5804