Provider Demographics
NPI:1083380661
Name:GIANT EAGLE LONG TERM CARE, LLC
Entity Type:Organization
Organization Name:GIANT EAGLE LONG TERM CARE, LLC
Other - Org Name:GIANT EAGLE LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE CONTRACTING & CREDENTIALI
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-967-4775
Mailing Address - Street 1:101 KAPPA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2833
Mailing Address - Country:US
Mailing Address - Phone:412-967-4775
Mailing Address - Fax:
Practice Address - Street 1:6204 STATE ROUTE 30 STE A
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6399
Practice Address - Country:US
Practice Address - Phone:724-836-6779
Practice Address - Fax:412-968-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy