Basic Information
| Provider Information | |||||||||
| NPI: | 1023330289 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LATROBE HEALTH LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LATROBE HEALTH AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 576 FRED ROGERS DR | ||||||||
| Address2: | |||||||||
| City: | LATROBE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156503822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245374441 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 576 FRED ROGERS DR | ||||||||
| Address2: | |||||||||
| City: | LATROBE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156503822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245374441 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2010 | ||||||||
| LastUpdateDate: | 03/02/2010 | ||||||||
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| AuthorizedOfficialLastName: | KLEIN | ||||||||
| AuthorizedOfficialFirstName: | AVI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7245374447 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | PA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 395892 | 01 | PA | MEDICARE | OTHER |