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Organization
COUNTRYSIDE CONVALESCENT HOME LIMITED PARTNERSHIP
Active
Organization
COUNTRYSIDE CONVALESCENT HOME LIMITED PARTNERSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN D TACK NHA (CEO)
(724) 431-0770
Entity
Organization
Contact information
Practice address
8221 LAMOR RD, MERCER, PA 16137-3163
(724) 431-0770
(724) 431-0764
Mailing address
8221 LAMOR RD, MERCER, PA 16137-3163
(724) 431-0770
(724) 431-0764
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012990090001
—
PA
01
—
1121
HIGHMARK BC
—
01
—
1501006
GATEWAY HP
PA
01
—
263249
HEALTH AMERICA
PA
01
—
305354
UPMC
—
Enumeration date
09/06/2005
Last updated
08/14/2014
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