Provider Demographics
NPI:1629076930
Name:HARMARVILLAGE CARE CENTER, LLC
Entity Type:Organization
Organization Name:HARMARVILLAGE CARE CENTER, LLC
Other - Org Name:HARMARVILLAGE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT 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 1:715 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:CHESWICK
Practice Address - State:PA
Practice Address - Zip Code:15024-1205
Practice Address - Country:US
Practice Address - Phone:724-274-3773
Practice Address - Fax:724-274-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA086002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA251143OtherHEALTH ASSURANCE
PA0018363060001Medicaid
PA0070023400OtherBLACK LUNG PROVIDER NO.
PA217005OtherUPMC PROVIDER NUMBERS
PA1380OtherBLUE CROSS PROVIDER NO.
PA251143OtherHEALTH AMERICA
PA000000101279OtherTHREE RIVERS PROV. NO.
PA1380OtherSECURITY BLUE
PA251143OtherADVANTRA
PA000000101279OtherMEDPLUS PROVIDER NUMBER
PA1503832OtherGATEWAY PROVIDER NUMBER
PA1530729OtherUMWA PROVIDER NUMBER
PA217005OtherUPMC PROVIDER NUMBERS