Provider Demographics
NPI:1205822418
Name:DUBOIS CONTINUUM OF CARE COMMUNITY, INC.
Entity Type:Organization
Organization Name:DUBOIS CONTINUUM OF CARE COMMUNITY, INC.
Other - Org Name:DUBOIS NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:NESBIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-375-9100
Mailing Address - Street 1:212 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2811
Mailing Address - Country:US
Mailing Address - Phone:814-375-9100
Mailing Address - Fax:814-375-3979
Practice Address - Street 1:212 S 8TH ST
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2811
Practice Address - Country:US
Practice Address - Phone:814-375-9100
Practice Address - Fax:814-375-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA560402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007463490002Medicaid
PA395430Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER