Provider Demographics
NPI:1164485777
Name:OSPTA HOME, LLC
Entity Type:Organization
Organization Name:OSPTA HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:FURLONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:724-483-4859
Mailing Address - Street 1:625 LINCOLN AVE
Mailing Address - Street 2:PROFESSIONAL PLAZA SUITE 207
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-2451
Mailing Address - Country:US
Mailing Address - Phone:724-483-4859
Mailing Address - Fax:724-483-4793
Practice Address - Street 1:625 LINCOLN AVE
Practice Address - Street 2:PROFESSIONAL PLAZA SUITE 107
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-2451
Practice Address - Country:US
Practice Address - Phone:724-483-4859
Practice Address - Fax:724-483-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02170501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2086OtherHIGHMARK
PA397798Medicare ID - Type Unspecified