Healthcare Provider Details

I. General information

NPI: 1578556528
Provider Name (Legal Business Name): LONGWOOD AT OAKMONT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ROUTE 909
VERONA PA
15147-3831
US

IV. Provider business mailing address

500 ROUTE 909
VERONA PA
15147-3831
US

V. Phone/Fax

Practice location:
  • Phone: 412-826-5707
  • Fax: 412-826-6906
Mailing address:
  • Phone: 412-826-5707
  • Fax: 412-826-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number017202
License Number StatePA

VIII. Authorized Official

Name: MR. JOSEPH A WENGER
Title or Position: ASSOC EXEC DIRECTOR
Credential:
Phone: 412-826-5704