Provider Demographics
NPI:1588641757
Name:SIEMON NURSING HOME, INC
Entity Type:Organization
Organization Name:SIEMON NURSING HOME, INC
Other - Org Name:SIEMONS' LAKEVIEW MANOR ESTATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SIEMON
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:814-443-2811
Mailing Address - Street 1:228 SIEMON DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-7055
Mailing Address - Country:US
Mailing Address - Phone:814-443-2811
Mailing Address - Fax:814-445-3210
Practice Address - Street 1:228 SIEMON DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-7055
Practice Address - Country:US
Practice Address - Phone:814-443-2811
Practice Address - Fax:814-445-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA970202313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007486200001Medicaid
395398Medicare ID - Type Unspecified