Provider Demographics
NPI:1457024275
Name:CHARIOT EBENSBURG ALF OPCO LLC
Entity Type:Organization
Organization Name:CHARIOT EBENSBURG ALF OPCO LLC
Other - Org Name:AMBER HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR PROVIDER CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:814-277-4500
Mailing Address - Street 1:270 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7097
Mailing Address - Country:US
Mailing Address - Phone:814-277-4500
Mailing Address - Fax:
Practice Address - Street 1:429 MANOR DR
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4917
Practice Address - Country:US
Practice Address - Phone:814-472-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility