Provider Demographics
NPI:1417953837
Name:NUGENT CONVALESCENT HOME, INC
Entity Type:Organization
Organization Name:NUGENT CONVALESCENT HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-981-6610
Mailing Address - Street 1:500 CLARKSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148
Mailing Address - Country:US
Mailing Address - Phone:724-981-6610
Mailing Address - Fax:724-981-3224
Practice Address - Street 1:500 CLARKSVILLE RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2954
Practice Address - Country:US
Practice Address - Phone:724-981-6610
Practice Address - Fax:724-981-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1407314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0645OtherBLUE CROSS PROVIDER #
PA313583OtherUPMC HEALTH PLAN PROVIDER
PA0645OtherBLUE CROSS PROVIDER #