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 |
| 1 | 314000000X | Skilled Nursing Facility | | 0114 02 | PENNSYLVANIA | No |
| 2 | 310400000X | Assisted Living Facility | | 145350 | PENNSYLVANIA | Yes |
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 |
| 1 | 0101946401 | OTHER | PENNSYLVANIA | AMERICHOICE |
| 2 | 0006002 000 | OTHER | PENNSYLVANIA | BLUE CROSS KEYSTONE |
| 3 | 116981 0001 | OTHER | PENNSYLVANIA | DMERC A MEDICARE |
| 4 | 000756210 0001 | MEDICAID | PENNSYLVANIA | |
| 5 | 1052293 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 6 | 13112 | OTHER | PENNSYLVANIA | AETNA US HEALTHCARE |
| 7 | 20134 | OTHER | PENNSYLVANIA | HEALTH PARTNERS SENIOR PA |
