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General NPI Number Information
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NPI Number | 1023018504
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Entity Type | Organization
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Legal Business Name | FAIR WINDS MANOR, LP
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Dates
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Enumeration Date | 07/27/2005
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Last Update Date | 03/15/2015
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Provider Practice Location Address
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Address Line | 126 IRON BRIDGE RD
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City | SARVER
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State | PA
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Zip | 16055-8603
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Country | US
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Telephone | 724-353-1531
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Fax | 724-353-1117
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Provider Business Mailing Address
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Address Line | 126 IRON BRIDGE RD
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City | SARVER
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State | PA
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Zip | 16055-8603
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Country | US
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Telephone | 724-353-1531
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Fax | 724-353-1117
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Authorized Official
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Title or Position | CEO
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Name | STEVEN D TACK
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Credential |
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Telephone | 724-431-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 060102
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License Number State | PA
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