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General NPI Number Information
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NPI Number | 1134315708
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Entity Type | Organization
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Legal Business Name | REST HAVEN PERSONAL CARE HOME
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 122 VALLEY RD
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City | CANONSBURG
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State | PA
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Zip | 15317-1218
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Country | US
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Telephone | 724-746-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 314 ROSS ST
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City | HOUSTON
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State | PA
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Zip | 15342-1142
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARILYN DERESH
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Credential |
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Telephone | 724-746-4666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 448360
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License Number State | PA
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