Provider Demographics
NPI:1629074935
Name:VINCENTIAN HOME
Entity Type:Organization
Organization Name:VINCENTIAN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KULL
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:412-366-5600
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 1:111 PERRYMONT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5239
Practice Address - Country:US
Practice Address - Phone:412-366-5600
Practice Address - Fax:412-366-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007499890003Medicaid
PA0647OtherHIGHMARK PROVIDER NUMBER
PA1007499890003Medicaid