Provider Demographics
NPI:1275536476
Name:VILLA ST JOSEPH OF BADEN INC
Entity Type:Organization
Organization Name:VILLA ST JOSEPH OF BADEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:NHA, MPH
Authorized Official - Phone:724-869-6310
Mailing Address - Street 1:1030 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:BADEN
Mailing Address - State:PA
Mailing Address - Zip Code:15005-1338
Mailing Address - Country:US
Mailing Address - Phone:724-869-6300
Mailing Address - Fax:724-869-6399
Practice Address - Street 1:1030 STATE STREET
Practice Address - Street 2:
Practice Address - City:BADEN
Practice Address - State:PA
Practice Address - Zip Code:15005-1338
Practice Address - Country:US
Practice Address - Phone:724-869-6300
Practice Address - Fax:724-869-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA069302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016442270002Medicaid
PA0016442270002Medicaid
PA396026Medicare ID - Type Unspecified