=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578721312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRATT PERSONAL CARE HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2008
-----------------------------------------------------
Last Update Date | 05/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 179 PRATT ROAD
-----------------------------------------------------
City | CARMICHAELS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-966-2120
-----------------------------------------------------
Fax | 724-966-7951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | BOX 263
-----------------------------------------------------
City | CARMICHAELS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-966-2120
-----------------------------------------------------
Fax | 724-966-7951
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. BETTY JEAN PRATT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-966-2120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------