Provider Demographics
NPI:1083718548
Name:THE HERITAGE SHADYSIDE
Entity Type:Organization
Organization Name:THE HERITAGE SHADYSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NIGRO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:412-864-3532
Mailing Address - Street 1:200 LOTHROP ST STE 10097
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2536
Mailing Address - Country:US
Mailing Address - Phone:412-864-3532
Mailing Address - Fax:412-864-3554
Practice Address - Street 1:5701 PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2254
Practice Address - Country:US
Practice Address - Phone:412-422-5100
Practice Address - Fax:412-422-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA086102313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
V6004AOtherUPMC HEALTH PLAN
PA0019010200001Medicaid
0477OtherHIGHMARK BLUE CROSS
0477OtherHIGHMARK BLUE CROSS