Basic Information
| Provider Information | |||||||||
| NPI: | 1457449563 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HUNTINGDON NURSING CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FRIENDLY NURSING HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40213 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708350213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257530864 | ||||||||
| FaxNumber: | 2257530948 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 TAYLORSVILLE MOUNTAIN RD | ||||||||
| Address2: | |||||||||
| City: | PITMAN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179649104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706440489 | ||||||||
| FaxNumber: | 5706440981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PITTMAN | ||||||||
| AuthorizedOfficialFirstName: | CINDIE | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2257530864 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 061502 | PA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 1007564000009 | 05 | PA | MEDICAID |