MEDICARE: LAS GERIATRIC CARE SERVICES, INC.

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
1	261QR0400X	Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ST00393521	OTHER	PA	BCBS
2	OT0003667704	OTHER	PA	BCBS
3	PT00366875	OTHER	PA	BCBS

General Provider Information

NPI Number	:	1356349237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS GERIATRIC CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	1323 FREEDOM RD
Second Line	:
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-5001
Country	:	US
Telephone Number	:	724-776-1100
Fax Number	:	724-776-1108

Provider Business Practice Location Address
First Line	:	1323 FREEDOM RD
Second Line	:
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-5001
Country	:	US
Telephone Number	:	724-776-1100
Fax Number	:	724-776-1108

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MS. SUSAN Q DIGIROLAMO
Credential	:	CPA
Telephone Number	:	724-742-2246

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/07/2008

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