Sugar Creek Rest, LTD PTR
Organization Active NPI Nursing Facility/Intermediate Care Facility · Worthington, PA
NPI 1386637809 · NPPES record last updated Aug 14, 2014
Key facts
- NPI
- 1386637809
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nursing Facility/Intermediate Care Facility 313M00000X
- License
- 195002 (PA)
- Legal business name
- SUGAR CREEK REST, LTD PTR
- Practice address
- 120 Lakeside Dr
Worthington, PA 16262-5102 - Phone
- (724) 445-3146
- Fax
- (724) 445-3186
- NPI assigned
- Aug 30, 2005
- Organization subpart
- No
Authorized official
- Name
- Steven D Tack, NHA
- Title
- Ceo
- Phone
- (724) 431-0770
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | 195002 | PA | Yes |
Addresses
Primary practice location
120 Lakeside Dr
Worthington, PA 16262-5102
Mailing address
120 Lakeside Dr
Worthington, PA 16262-5102
Phone (724) 445-3146
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000966807001 | Medicaid | PA | |
| 1039012 | Other | PA | GATEWAY HP |
| 111736 | Other | PA | UNISON |
| 0613 | Other | HIGHMARK BC | |
| 263510 | Other | PA | HEALTH AMERICA |
| 209144 | Other | UPMC | |
| 0240400001 | Other | MA | NHIC,CORP |
Other providers in Worthington, PA
- Amber Elaine Crownover
- Paul Richard Daisley
- JLR PC Adam Associates
- Quality Life Services - Sugar Creek, LLC
- Brandon Snickles
- Kristina Sue Totin
- Joyce Witkiewicz-Bowser
All providers in Worthington, PA · Nursing Facility/Intermediate Care Facility in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.