Healthcare Provider Details

I. General information

NPI: 1902806854
Provider Name (Legal Business Name): CHURCH OF THE BRETHREN HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 HOFFMAN AVE
WINDBER PA
15963-2369
US

IV. Provider business mailing address

277 HOFFMAN AVE
WINDBER PA
15963-2369
US

V. Phone/Fax

Practice location:
  • Phone: 814-467-5505
  • Fax: 814-361-6412
Mailing address:
  • Phone: 814-467-5505
  • Fax: 814-361-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number032602
License Number StatePA

VIII. Authorized Official

Name: THOMAS RECKNER
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 814-467-5505