Provider Demographics
NPI:1093860215
Name:ESSENT HEALTHCARE - WAYNESBURG LLC
Entity Type:Organization
Organization Name:ESSENT HEALTHCARE - WAYNESBURG LLC
Other - Org Name:SRMC SKILLED NURSING UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-844-9849
Mailing Address - Street 1:350 BONAR AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1608
Mailing Address - Country:US
Mailing Address - Phone:724-627-2645
Mailing Address - Fax:
Practice Address - Street 1:350 BONAR AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1608
Practice Address - Country:US
Practice Address - Phone:724-627-2645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA852102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015525580001Medicaid
PA395887Medicare Oscar/Certification