Provider Demographics
NPI:1639241797
Name:CLARVIEW REST HOME, INC.
Entity Type:Organization
Organization Name:CLARVIEW REST HOME, INC.
Other - Org Name:CLARVIEW NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:814-745-2031
Mailing Address - Street 1:14663 ROUTE 68
Mailing Address - Street 2:
Mailing Address - City:SLIGO
Mailing Address - State:PA
Mailing Address - Zip Code:16255
Mailing Address - Country:US
Mailing Address - Phone:814-745-2031
Mailing Address - Fax:814-745-3010
Practice Address - Street 1:14663 ROUTE 68
Practice Address - Street 2:
Practice Address - City:SLIGO
Practice Address - State:PA
Practice Address - Zip Code:16255
Practice Address - Country:US
Practice Address - Phone:814-745-2031
Practice Address - Fax:814-745-3010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARVIEW REST HOME, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-14
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
PA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000750493Medicaid
PA000750493Medicaid