Provider Demographics
NPI:1801893664
Name:SENIOR CHOICE,INC
Entity type:Organization
Organization Name:SENIOR CHOICE,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:814-445-4549
Mailing Address - Street 1:495 W PATRIOT ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1503
Mailing Address - Country:US
Mailing Address - Phone:814-445-4549
Mailing Address - Fax:814-443-2631
Practice Address - Street 1:495 W PATRIOT ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1503
Practice Address - Country:US
Practice Address - Phone:814-445-4549
Practice Address - Fax:814-443-2631
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIOR CHOICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-07
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA167902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA732237OtherBLACK LUNG PROVIDER ID
PA1801893664OtherNPI
PA1001324140008Medicaid
PA0663OtherBLUE CROSS PROVIDER ID
PA1474635OtherUMWA PROVIDER ID
PA1801893664OtherNPI
PA1001324140008Medicaid