Healthcare Provider Details

I. General information

NPI: 1164907846
Provider Name (Legal Business Name): GUARDIAN ELDER CARE AT TAYLOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W HOSPITAL ST
TAYLOR PA
18517-2012
US

IV. Provider business mailing address

8796 ROUTE 219
BROCKWAY PA
15824-6010
US

V. Phone/Fax

Practice location:
  • Phone: 570-562-2102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier103569901-0001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

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