Provider Demographics
NPI:1881690295
Name:VINCENTIAN REGENCY
Entity Type:Organization
Organization Name:VINCENTIAN REGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GENOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:412-366-8540
Mailing Address - Street 1:9399 BABCOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-2008
Mailing Address - Country:US
Mailing Address - Phone:412-366-8540
Mailing Address - Fax:412-369-9789
Practice Address - Street 1:9399 BABCOCK BLVD
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-2008
Practice Address - Country:US
Practice Address - Phone:412-366-8540
Practice Address - Fax:412-369-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0576OtherHIGHMARK PROVIDER NUMBER
PA1007742390003Medicaid
PA1007742390003Medicaid