=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770008732
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHESWICK REHABILITATION AND WELLNESS CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2017
-----------------------------------------------------
Last Update Date | 05/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3876 SAXONBURG BLVD
-----------------------------------------------------
City | CHESWICK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15024-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-767-4998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3876 SAXONBURG BLVD
-----------------------------------------------------
City | CHESWICK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-767-4998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. LYNN DESMET
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 412-767-4998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------