Basic Information
| Provider Information | |||||||||
| NPI: | 1508902057 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWESTERN SENIOR CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 FORT COUCH RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152411030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128311223 | ||||||||
| FaxNumber: | 4128311034 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 FORT COUCH RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152411030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128311223 | ||||||||
| FaxNumber: | 4128311034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 05/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCHOLLAERT | ||||||||
| AuthorizedOfficialFirstName: | SUZANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4128311223 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 1013698590001 | 05 | PA | MEDICAID |