Healthcare Provider Details

I. General information

NPI: 1952359457
Provider Name (Legal Business Name): SCOTTDALE MANOR REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PORTER AVE
SCOTTDALE PA
15683-1147
US

IV. Provider business mailing address

8796 ROUTE 219
BROCKWAY PA
15824-6010
US

V. Phone/Fax

Practice location:
  • Phone: 724-887-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number232802
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL EPERESI
Title or Position: CFO
Credential:
Phone: 814-265-1164