Healthcare Provider Details

I. General information

NPI: 1467455220
Provider Name (Legal Business Name): COUNTY OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 OLD HICKORY RIDGE RD
WASHINGTON PA
15301-8613
US

IV. Provider business mailing address

36 OLD HICKORY RIDGE RD
WASHINGTON PA
15301-8613
US

V. Phone/Fax

Practice location:
  • Phone: 724-228-5010
  • Fax: 724-223-7187
Mailing address:
  • Phone: 724-228-5010
  • Fax: 724-223-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number751102
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1002272960004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1296031
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUMWA
# 3
Identifier0561
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE CROSS
# 4
Identifier1502821
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGATEWAY
# 5
Identifier90851
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerTHREE RIVERS MED PLUS
# 6
Identifier53252
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerADVANTRA
# 7
IdentifierV0023A
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC FOR YOU
# 8
Identifier100227960004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: LYNN M SNYDER
Title or Position: FISCAL DIRECTOR
Credential:
Phone: 724-228-5010