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General NPI Number Information
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NPI Number | 1306859756
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Entity Type | Organization
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Legal Business Name | CONVALESCENT CENTER GROUP
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 506 ATHENA DR
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City | DELMONT
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State | PA
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Zip | 15626-1005
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Country | US
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Telephone | 724-468-6869
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Fax | 724-468-6207
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Provider Business Mailing Address
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Address Line | 506 ATHENA DR
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City | DELMONT
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State | PA
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Zip | 15626-1005
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Country | US
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Telephone | 724-468-6869
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Fax | 724-468-6207
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS DEGREGORY
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Credential | DO
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Telephone | 724-468-6869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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