Basic Information
| Provider Information | |||||||||
| NPI: | 1871551028 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CORE NETWORK, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CENTERS FOR REHAB SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | MCKEESPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151322806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126736660 | ||||||||
| FaxNumber: | 4126733319 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | MCKEESPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126736660 | ||||||||
| FaxNumber: | 4126733319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 07/26/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROCKAR | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 4126736660 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MS, PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 224Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 225200000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 261314 | 01 | PA | HIGHMARK (ST) | OTHER | 1514485 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 1761232 | 05 | PA | MEDICAID | 263048 | 01 | PA | HIGHMARK (OT) | OTHER | 703642 | 01 | PA | HIGHMARK (PT) | OTHER |