Basic Information
Provider Information | |||||||||
NPI: | 1467635375 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | UPMC KANE | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | UPMC KANE SNF | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4372 ROUTE 6 | ||||||||
Address2: |   | ||||||||
City: | KANE | ||||||||
State: | PA | ||||||||
PostalCode: | 167353060 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8148378585 | ||||||||
FaxNumber: | 8148374348 | ||||||||
Practice Location | |||||||||
Address1: | 4372 ROUTE 6 | ||||||||
Address2: |   | ||||||||
City: | KANE | ||||||||
State: | PA | ||||||||
PostalCode: | 167353060 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8148378585 | ||||||||
FaxNumber: | 8148374348 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/13/2007 | ||||||||
LastUpdateDate: | 05/12/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RHODES | ||||||||
AuthorizedOfficialFirstName: | JOHN | ||||||||
AuthorizedOfficialMiddleName: | GARY | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 8148378585 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | UPMC HAMOT | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | 550501 | PA | Y |   | Hospital Units | Medicare Defined Swing Bed Unit |   |
ID Information
ID | Type | State | Issuer | Description | 0464 | 01 | PA | HIGHMARK SNF | OTHER |