University Park Nursing, LP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

940502 Issued in PA

Legal business name

UNIVERSITY PARK NURSING, LP

Doing business as

The Hearthside, A Nursing & Rehabilitation Center

Practice address

450 Waupelani Drive
State College, PA 16801-4516

Phone

(814) 237-0630

Fax

(814) 237-1803

NPI assigned

Apr 11, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Peter J Licari

Title

President

Phone

(215) 441-7700

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• The Hearthside, A Nursing & Rehabilitation Center Doing business as

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242604800000",
    "number": "1174586002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 WAUPELANI DRIVE",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168014516",
            "telephone_number": "814-237-0630",
            "fax_number": "814-237-1803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 WAUPELANI DRIVE",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168014516",
            "telephone_number": "814-237-0630",
            "fax_number": "814-237-1803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY PARK NURSING, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2009-05-18",
        "status": "A",
        "authorized_official_last_name": "LICARI",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-441-7700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "940502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101188085",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4901777625",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Hearthside, A Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.