Provider Demographics
NPI:1588660906
Name:VINCENTIAN DE MARILLAC
Entity Type:Organization
Organization Name:VINCENTIAN DE MARILLAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-548-4073
Mailing Address - Street 1:8250 BABCOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5825
Mailing Address - Country:US
Mailing Address - Phone:412-548-4073
Mailing Address - Fax:412-348-0186
Practice Address - Street 1:5300 STANTON AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-2083
Practice Address - Country:US
Practice Address - Phone:412-361-2833
Practice Address - Fax:412-361-2833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0251OtherHIGHMARK BC PROVIDER #
PA100745620003Medicaid
PA395842Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER