NPIMap

Organization Active NPI

Lung & Wellness Centers of Western Pennsylvania Inc

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Beaver, PA
National Provider Identifier
1023540143
Registry record updated May 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
LUNG & WELLNESS CENTERS OF WESTERN PENNSYLVANIA INC
Practice address
1701 3Rd St
Beaver, PA 15009-2432
Phone
(878) 207-2192
Fax
(878) 207-2193
NPI assigned
Mar 29, 2017
Last updated
May 24, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kelli ThompsonNPI 1467892067
Title
President
Phone
(724) 256-9606

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X NU Primary

Addresses

Primary practice location

1701 3Rd St
Beaver, PA 15009-2432

Mailing address

200 Renaissance Dr Ste 103
Butler, PA 16001-7612
Phone (724) 256-9606

Other identifiers 1

IdentifierTypeStateIssuer
1028747070003MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180124002682 PA Part A Provider - Comprehensive Outpatient Rehabilitation Facility 4587815428 Practice locations: Beaver, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023540143. Details of each certification follow.

  • CCN 394575 Comprehensive outpatient rehabilitation facility · Active · Name & address match · Details

Comprehensive outpatient rehabilitation facility certification: CCN 394575

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LUNG & WELLNESS CENTERS OF WESTERN PENNSYLVANIA IN
Certification status
Active
Provider type (POS)
Comprehensive outpatient rehabilitation facility
Participating since
Dec 13, 2017
Last certification
Dec 5, 2023
Ownership / control type
Proprietary
Facility address
1701 3Rd Street Suite 4
Beaver, PA 15009

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Lung Wellness Centers of W PA Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558656000000",
    "number": "1023540143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 RENAISSANCE DR STE 103",
            "city": "BUTLER",
            "state": "PA",
            "postal_code": "160017612",
            "telephone_number": "724-256-9606",
            "fax_number": "724-256-9609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 3RD ST",
            "city": "BEAVER",
            "state": "PA",
            "postal_code": "150092432",
            "telephone_number": "878-207-2192",
            "fax_number": "878-207-2193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUNG & WELLNESS CENTERS OF WESTERN PENNSYLVANIA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-29",
        "last_updated": "2019-05-24",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "724-256-9606"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1028747070003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver, PA

Sources for this page

Verify at the official NPI Registry.