# SUGAR CREEK REST, LTD PTR

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386637809
- **Authorized official:** STEVEN D TACK NHA (CEO)
- **Authorized official phone:** (724) 431-0770

## Contact information

- **Practice address:** 120 LAKESIDE DR, WORTHINGTON, PA 16262-5102
- **Practice address phone:** (724) 445-3146
- **Practice address fax:** (724) 445-3186
- **Mailing address:** 120 LAKESIDE DR, WORTHINGTON, PA 16262-5102
- **Mailing address phone:** (724) 445-3146
- **Mailing address fax:** (724) 445-3186

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 195002 | PA | Yes |

## Other

- **Enumeration date:** 08/30/2005
- **Last updated:** 08/14/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000966807001 | — | PA |
| 01 | — | 0240400001 | NHIC,CORP | MA |
| 01 | — | 0613 | HIGHMARK BC | — |
| 01 | — | 1039012 | GATEWAY HP | PA |
| 01 | — | 111736 | UNISON | PA |
| 01 | — | 209144 | UPMC | — |
| 01 | — | 263510 | HEALTH AMERICA | PA |