Healthcare Provider Details

I. General information

NPI: 1902897424
Provider Name (Legal Business Name): WOODCREST ASSISTED LIVING LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WOODCREST CIR
SCOTTDALE PA
15683-9539
US

IV. Provider business mailing address

1 WOODCREST CIR
SCOTTDALE PA
15683-9539
US

V. Phone/Fax

Practice location:
  • Phone: 724-887-3773
  • Fax: 724-887-7659
Mailing address:
  • Phone: 724-887-3773
  • Fax: 724-887-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number000790
License Number StatePA

VIII. Authorized Official

Name: MRS. JUDY FRETTS
Title or Position: ADMINISTRATOR
Credential: PCH ADMINISTRATOR
Phone: 742-887-3773