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NPI Code Detail

MEDICARE: MAHONING VALLEY CONVALESCENT HOME, INC.

MEDICARE: MAHONING VALLEY CONVALESCENT HOME, 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
1314000000XSkilled Nursing Facility130202PA

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 : 1598765489
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAHONING VALLEY CONVALESCENT HOME, INC.
Provider Business Mailing Address
First Line : 397 HEMLOCK DR
Second Line :
City : LEHIGHTON
State : PA
Zip : 18235-9712
Country : US
Telephone Number : 570-386-5522
Fax Number : 570-386-3292
Provider Business Practice Location Address
First Line : 397 HEMLOCK DR
Second Line :
City : LEHIGHTON
State : PA
Zip : 18235-9712
Country : US
Telephone Number : 570-386-5522
Fax Number : 570-386-3292
Authorized Official
Title or Position : PRESIDENT / C.E.O.
Name : MR. MICHAEL ANDREW MICKEY
Credential :
Telephone Number : 570-386-5522
Provider Enumeration Date : 07/21/2005
Last Update Date : 08/22/2020

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Directions to “MAHONING VALLEY CONVALESCENT HOME, INC. ” Practice Location

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