Provider Demographics
NPI:1881637551
Name:BEVERLY ENTERPRISES - PENNSYLVANIA, INC.
Entity Type:Organization
Organization Name:BEVERLY ENTERPRISES - PENNSYLVANIA, INC.
Other - Org Name:BEVERLY LIVINGCENTER - MOUNTAIN VIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RASMUSSEN-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-201-4835
Mailing Address - Street 1:383 MOUNTAIN VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15746
Mailing Address - Country:US
Mailing Address - Phone:814-743-6613
Mailing Address - Fax:
Practice Address - Street 1:383 MOUNTAIN VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:PA
Practice Address - Zip Code:15746
Practice Address - Country:US
Practice Address - Phone:814-743-6613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEVERLY HEALTH AND REHABILITATION SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-13
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1126689Medicaid
PA1505672OtherGATEWAY
PA126206OtherHEALTHAMERICA
PA0644OtherHIGHMARK
PA000000077080OtherTRHP
PA523594OtherAETNA
PA000000077080OtherTRHP