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General NPI Number Information
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NPI Number | 1902806854
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Entity Type | Organization
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Legal Business Name | CHURCH OF THE BRETHREN HOME
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 277 HOFFMAN AVE
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City | WINDBER
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State | PA
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Zip | 15963-2369
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Country | US
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Telephone | 814-467-5505
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Fax | 814-361-6412
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Provider Business Mailing Address
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Address Line | 277 HOFFMAN AVE
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City | WINDBER
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State | PA
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Zip | 15963-2369
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Country | US
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Telephone | 814-467-5505
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Fax | 814-361-6412
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | THOMAS RECKNER
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Credential | NHA
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Telephone | 814-467-5505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 032602
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License Number State | PA
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