Organization
SOUTH FAYETTE NURSING CENTER, LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN D TACK (CEO)
(724) 431-0770
Entity
Organization
Contact information
Practice address
252 MAIN ST, MARKLEYSBURG, PA 15459-1202
(724) 329-4830
(724) 329-1503
Mailing address
252 MAIN ST, MARKLEYSBURG, PA 15459-1202
(724) 329-4830
(724) 329-1503
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
453602
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019298830001
—
PA
01
—
10360
GATEWAY HEALTH PLAN
—
01
—
PENDING
HIGHMARK BC
PA
Enumeration date
07/27/2005
Last updated
08/14/2014
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