Provider Demographics
NPI:1710474838
Name:SCOTT, SABRINA LYNN SR (OWNER)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:LYNN
Last Name:SCOTT
Suffix:SR
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SMITHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-2248
Mailing Address - Country:US
Mailing Address - Phone:412-595-4571
Mailing Address - Fax:
Practice Address - Street 1:114 SMITHFIELD ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-2248
Practice Address - Country:US
Practice Address - Phone:412-595-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA36293601310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA36293601OtherNON MEDICAL HOME CARE