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NPI Code Detail

MEDICARE: THI OF PENNSYLVANIA AT GREENERY OF CANONSBURG LLC

MEDICARE: THI OF PENNSYLVANIA AT GREENERY OF CANONSBURG LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility135602PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316934680
Entity Type Code : Organization
Provider Name (Legal Business Name) : THI OF PENNSYLVANIA AT GREENERY OF CANONSBURG LLC
Provider Business Mailing Address
First Line : 920 RIDGEBROOK RD
Second Line :
City : SPARKS
State : MD
Zip : 21152-9390
Country : US
Telephone Number : 410-773-1000
Fax Number :
Provider Business Practice Location Address
First Line : 2200 HILL CHURCH HOUSTON RD
Second Line :
City : CANONSBURG
State : PA
Zip : 15317-1454
Country : US
Telephone Number : 724-745-8000
Fax Number : 724-745-3245
Authorized Official
Title or Position : ADMINISTRATOR
Name : ANDREW LEROY
Credential :
Telephone Number : 724-745-8000
Provider Enumeration Date : 10/03/2005
Last Update Date : 06/29/2011

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