Provider Demographics
NPI:1619975927
Name:GREENSBURG CARE CENTER, LLC
Entity Type:Organization
Organization Name:GREENSBURG CARE CENTER, LLC
Other - Org Name:GREENSBURG CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:HENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-963-9150
Mailing Address - Street 1:209 SIGMA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2826
Mailing Address - Country:US
Mailing Address - Phone:412-963-9150
Mailing Address - Fax:412-963-6676
Practice Address - Street 1:119 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6990
Practice Address - Country:US
Practice Address - Phone:724-836-2480
Practice Address - Fax:724-836-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA073502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA114450OtherMED PLUS
PA0018362800002Medicaid
PA0566OtherHIGHMARK BC BS
PA114450OtherUNISON & OR THREE RIVERS
PA1513763OtherGATEWAY
PA251138OtherADVANTRA
PA251138OtherHEALTH AMERICA &ASSURANCE
PA0566OtherSECURITY BLUE
PA114450OtherMED PLUS
PA1513763OtherGATEWAY
PA251138OtherADVANTRA
PA=========OtherUPMC
PA=========OtherTRICARE
PA0018362800002Medicaid
PA395604Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER