SUGAR CREEK REST LTD PTR NPI 1386637809

NPI Information

  • NPI: 1386637809
  • Provider Name: SUGAR CREEK REST, LTD PTR
  • Classification: Nursing Facility/Intermediate Care Facility - 313M00000X
  • Entity Type: Organization
  • CLIA Number: 39D0884028
  • Address: 120 LAKESIDE DR
    WORTHINGTON, PA
    ZIP 16262
  • Phone: (724) 445-3146

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NPI Details

SUGAR CREEK REST, LTD PTR is a nursing facility intermediate care facility in Worthington, PA. The provider is an institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. SUGAR CREEK REST, LTD PTR NPI is 1386637809. The provider is registered as an organization entity type.

The provider's business location address is:

120 LAKESIDE DR
WORTHINGTON, PA
ZIP 16262-102
Phone: (724) 445-3146
Fax: (724) 445-3186

The provider's authorized official is Steven D Tack .
The authorized official title is Ceo and has the following contact phone number (724) 431-0770.

The CLIA number assigned to this NPI record is 39D0884028 - skilled nursing facility/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/30/2005 and was last updated on 8/14/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1313M00000XNursing Facility/Intermediate Care Facility195002PENNSYLVANIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1111736OTHERPENNSYLVANIAUNISON
2209144OTHERUPMC
31039012OTHERPENNSYLVANIAGATEWAY HP
40240400001OTHERMASSACHUSETTSNHIC,CORP
5000966807001MEDICAIDPENNSYLVANIA
6263510OTHERPENNSYLVANIAHEALTH AMERICA
7395410MEDICARE ID-TYPE UNSPECIFIED
80613OTHERHIGHMARK BC

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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