Provider Demographics
NPI:1306844295
Name:PASSAVANT RETIREMENT AND HEALTH CENTER
Entity Type:Organization
Organization Name:PASSAVANT RETIREMENT AND HEALTH CENTER
Other - Org Name:PASSAVANT RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:DIGIROLAMO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:724-742-2246
Mailing Address - Street 1:1323 FREEDOM RD
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5001
Mailing Address - Country:US
Mailing Address - Phone:724-776-1100
Mailing Address - Fax:724-776-1108
Practice Address - Street 1:401 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-1585
Practice Address - Country:US
Practice Address - Phone:724-776-1100
Practice Address - Fax:724-776-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
PA163602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007566400001Medicaid
0632OtherBLUE CROSS
PA0007566400001Medicaid