Provider Demographics
NPI:1619164464
Name:BREESE PERSONAL CARE
Entity Type:Organization
Organization Name:BREESE PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMA JO
Authorized Official - Middle Name:
Authorized Official - Last Name:BREESE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:724-948-3377
Mailing Address - Street 1:281 TIMBER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CLAYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15323-1324
Mailing Address - Country:US
Mailing Address - Phone:724-948-3333
Mailing Address - Fax:724-948-3923
Practice Address - Street 1:281 TIMBER LAKE RD
Practice Address - Street 2:
Practice Address - City:CLAYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15323-1324
Practice Address - Country:US
Practice Address - Phone:724-948-3333
Practice Address - Fax:724-948-3923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility