=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477565216
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAPTIST HOMES SOCIETY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2006
-----------------------------------------------------
Last Update Date | 12/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 489 CASTLE SHANNON BLVD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15234-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-572-8240
-----------------------------------------------------
Fax | 412-572-8294
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 489 CASTLE SHANNON BLVD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15234-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-572-8240
-----------------------------------------------------
Fax | 412-572-8294
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTROLLER
-----------------------------------------------------
Name | DIANE MICKAIL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 412-572-8240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 047490
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------