Provider Demographics
NPI:1689730004
Name:SCHENLEY GARDENS CORF LP
Entity Type:Organization
Organization Name:SCHENLEY GARDENS CORF LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-921-6100
Mailing Address - Street 1:3890 BIGELOW BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1152
Mailing Address - Country:US
Mailing Address - Phone:412-621-4200
Mailing Address - Fax:
Practice Address - Street 1:3890 BIGELOW BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1152
Practice Address - Country:US
Practice Address - Phone:412-621-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCHENLEY GARDENS CORF LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-29
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA235Z00000X, 261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1700997OtherHIGHMARK SLP