Provider Demographics
NPI:1184629149
Name:REBECCA RESIDENCE
Entity Type:Organization
Organization Name:REBECCA RESIDENCE
Other - Org Name:CONCORDIA AT REBECCA RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-444-0600
Mailing Address - Street 1:3746 CEDAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-1048
Mailing Address - Country:US
Mailing Address - Phone:724-444-0600
Mailing Address - Fax:724-444-6621
Practice Address - Street 1:3746 CEDAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-1048
Practice Address - Country:US
Practice Address - Phone:724-444-0600
Practice Address - Fax:724-444-6621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA860102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1329OtherSKILLED NURSING
PA1329OtherSKILLED NURSING