MEDICARE: RESIDENCE FOR RENAL CARE AT SHADYSIDE, LTD

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	314000000X	Skilled Nursing Facility	033302	PA

General Provider Information

NPI Number	:	1699840645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENCE FOR RENAL CARE AT SHADYSIDE, LTD

Provider Business Mailing Address
First Line	:	5511 BAUM BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15232-1203
Country	:	US
Telephone Number	:	412-661-1740
Fax Number	:	412-661-7688

Provider Business Practice Location Address
First Line	:	5511 BAUM BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15232-1203
Country	:	US
Telephone Number	:	412-661-1740
Fax Number	:	412-661-7688

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE
Name	:	MR. ROBERT K NEALON
Credential	:
Telephone Number	:	412-661-1740

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	01/14/2008

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