Provider Demographics
NPI:1679575989
Name:GOLDEN HILL NURSING AND REHAB LP
Entity Type:Organization
Organization Name:GOLDEN HILL NURSING AND REHAB LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-431-0770
Mailing Address - Street 1:520 FRIENDSHIP ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-4596
Mailing Address - Country:US
Mailing Address - Phone:724-654-7791
Mailing Address - Fax:724-654-7891
Practice Address - Street 1:520 FRIENDSHIP ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-4596
Practice Address - Country:US
Practice Address - Phone:724-654-7791
Practice Address - Fax:724-654-7891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA850302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
0600OtherHIGHMARK BLUE CROSS
25-1150339OtherHOP ADMINISTRATOR - PSERS
215867OtherUPMC HEALTH PLAN
PA0007452610001Medicaid
76398OtherADVANTRA
PA1502705OtherGATEWAY HEALTH PLAN
395003Medicare ID - Type Unspecified