Organization
SENIOR LIFE ALTOONA, INC.
Active
Other names
Senior LIFE Ebensburg
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HERBERT H HENNELL (DIR. OF REIMBURSEMENT)
(412) 963-9150
Entity
Organization
Contact information
Practice address
429 MANOR DR, EBENSBURG, PA 15931-4917
(814) 472-6060
(814) 472-1293
Mailing address
209 SIGMA DR, PITTSBURGH, PA 15238-2826
(412) 963-9150
(412) 963-6676
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
253Z00000X
In Home Supportive Care Agency
22223601
PA
261QA0600X
Adult Day Care Clinic/Center
075064
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102565990-0001
—
PA
01
—
H5902
MEDICARE PACE PROGRAM AGREEMENT
PA
Enumeration date
02/15/2011
Last updated
09/26/2016
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