Provider Demographics
NPI:1952306474
Name:NUBRIDGE ASSOCIATES LP
Entity Type:Organization
Organization Name:NUBRIDGE ASSOCIATES LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSICKLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-981-2750
Mailing Address - Street 1:959 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-3331
Mailing Address - Country:US
Mailing Address - Phone:724-981-2750
Mailing Address - Fax:724-981-4703
Practice Address - Street 1:959 E STATE ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3331
Practice Address - Country:US
Practice Address - Phone:724-981-2750
Practice Address - Fax:724-981-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017855390001Medicaid
PA1363OtherBLUE CROSS PROVIDER #
PA318270OtherUPMC HEALTH PLAN PROVIDER
PA1363OtherBLUE CROSS PROVIDER #