Provider Demographics
NPI:1689384489
Name:60 HIGHLAND ROAD OPERATIONS LLC
Entity Type:Organization
Organization Name:60 HIGHLAND ROAD OPERATIONS LLC
Other - Org Name:BETHEL PARK SKILLED NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP AND ASST SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEAL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:505-468-4742
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:610-444-6350
Mailing Address - Fax:
Practice Address - Street 1:60 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1806
Practice Address - Country:US
Practice Address - Phone:412-831-6050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS PM PA OPERATIONS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-02
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020605390001Medicaid