Provider Demographics
NPI:1932412582
Name:NURSE SHARKS, INC.
Entity Type:Organization
Organization Name:NURSE SHARKS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:AGOSTI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CWCA, CFCN
Authorized Official - Phone:814-787-7365
Mailing Address - Street 1:405 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-1973
Mailing Address - Country:US
Mailing Address - Phone:814-787-7365
Mailing Address - Fax:888-398-6221
Practice Address - Street 1:661 BYRNEDALE RD
Practice Address - Street 2:
Practice Address - City:WEEDVILLE
Practice Address - State:PA
Practice Address - Zip Code:15868-1515
Practice Address - Country:US
Practice Address - Phone:814-787-7365
Practice Address - Fax:888-398-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009869313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility