Basic Information
| Provider Information | |||||||||
| NPI: | 1629685276 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMBASSY HUNTINGDON PARK, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25201 CHAGRIN BLVD | ||||||||
| Address2: | |||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225600 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1229 WARM SPRINGS AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGDON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166522350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146434210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2020 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| AuthorizedOfficialLastName: | REPCHICK | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT OF MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2163782050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.