Organization
FAIR WINDS MANOR, LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN D TACK (CEO)
(724) 431-0770
Entity
Organization
Contact information
Practice address
126 IRON BRIDGE RD, SARVER, PA 16055-8603
(724) 353-1531
(724) 353-1117
Mailing address
126 IRON BRIDGE RD, SARVER, PA 16055-8603
(724) 353-1531
(724) 353-1117
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
060102
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000092631
THREE RIVERS HEALTH PLAN
PA
05
—
1019292010001
—
PA
01
—
1511429
GATEWAY HEALTH PLAN
PA
01
—
PENDING
HIGHMARK BC
PA
Enumeration date
07/27/2005
Last updated
03/15/2015
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