Provider Demographics
NPI:1275649634
Name:PRESBYTERIAN HOME OF REDSTONE PRESBYTERY
Entity Type:Organization
Organization Name:PRESBYTERIAN HOME OF REDSTONE PRESBYTERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:PCA
Authorized Official - Phone:814-255-5539
Mailing Address - Street 1:787 GOUCHER ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-3028
Mailing Address - Country:US
Mailing Address - Phone:814-255-5539
Mailing Address - Fax:814-254-1809
Practice Address - Street 1:787 GOUCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3028
Practice Address - Country:US
Practice Address - Phone:814-255-5539
Practice Address - Fax:814-254-1809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA680102313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility