Provider Demographics
NPI:1235168519
Name:WILLIAM PENN CARE CENTER
Entity Type:Organization
Organization Name:WILLIAM PENN CARE CENTER
Other - Org Name:WILLIAM PENN CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-327-3500
Mailing Address - Street 1:2020 ADER RD
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-4500
Mailing Address - Country:US
Mailing Address - Phone:724-327-3500
Mailing Address - Fax:724-327-7320
Practice Address - Street 1:2020 ADER RD
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-4500
Practice Address - Country:US
Practice Address - Phone:724-327-3500
Practice Address - Fax:724-327-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA312402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001679750002Medicaid
PA1001679750002Medicaid