Provider Demographics
NPI:1639183817
Name:HCF OF EDINBORO, INC.
Entity Type:Organization
Organization Name:HCF OF EDINBORO, INC.
Other - Org Name:EDINBORO MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR - CORPORATE COMPLIANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STECHSCHULTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-999-2010
Mailing Address - Street 1:419 WATERFORD ST
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-5517
Mailing Address - Country:US
Mailing Address - Phone:814-734-5021
Mailing Address - Fax:814-734-1433
Practice Address - Street 1:419 WATERFORD ST
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-5517
Practice Address - Country:US
Practice Address - Phone:814-734-5021
Practice Address - Fax:814-734-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA053002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019250770001Medicaid
PA0987OtherSECURITY BLUE
PA000000099845OtherTHREE RIVERS/UNISON
PA305044OtherADVANTRA
PA395645Medicare Oscar/Certification