=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952870222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENN-ALLEGHENY NURSING AND REHABILITATION CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2018
-----------------------------------------------------
Last Update Date | 05/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6655 FRANKSTOWN AVE
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15206-4148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-665-3232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 368 NEW HEMPSTEAD RD # 317
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/MEMBER
-----------------------------------------------------
Name | JOSHUA KOENIG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-954-5653
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------