Provider Demographics
NPI:1184899494
Name:VIECARE BEAVER, LLC
Entity type:Organization
Organization Name:VIECARE BEAVER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V. P. FINANCIAL MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-742-2226
Mailing Address - Street 1:1323 FREEDOM RD
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5001
Mailing Address - Country:US
Mailing Address - Phone:724-776-1100
Mailing Address - Fax:724-776-0811
Practice Address - Street 1:131 PLEASANT DR
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-1384
Practice Address - Country:US
Practice Address - Phone:724-378-5400
Practice Address - Fax:724-302-2093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIECARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA001976540251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020790020001Medicaid