Provider Demographics
NPI:1780858910
Name:RICHARDSON'S CLARKSVILLE RESTHOME
Entity Type:Organization
Organization Name:RICHARDSON'S CLARKSVILLE RESTHOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIETTA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-377-9273
Mailing Address - Street 1:334 PITGAS RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15322-6345
Mailing Address - Country:US
Mailing Address - Phone:724-377-9273
Mailing Address - Fax:
Practice Address - Street 1:334 PITGAS RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15322-6345
Practice Address - Country:US
Practice Address - Phone:724-377-9273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA445200311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home