Prince Mark's Place

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

425900 Issued in PA

Legal business name

PRINCE MARK'S PLACE

Practice address

376 Pinecrest Dr
Lower Burrell, PA 15068-2330

Phone

(724) 337-6275

NPI assigned

May 6, 2013

Last updated

May 6, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephanie Dynka

Title

Ceo

Phone

(724) 337-6275

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1367798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367798400000",
    "number": "1467897231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "376 PINECREST DR",
            "city": "LOWER BURRELL",
            "state": "PA",
            "postal_code": "150682330",
            "telephone_number": "724-337-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "376 PINECREST DR",
            "city": "LOWER BURRELL",
            "state": "PA",
            "postal_code": "150682330",
            "telephone_number": "724-337-6275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCE MARK'S PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-06",
        "last_updated": "2013-05-06",
        "status": "A",
        "authorized_official_last_name": "DYNKA",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "724-337-6275"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "PA",
            "license": "425900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory Pierson
• Jordain Layne Pomycala, MS LAT ATC
• Robin Niccole Porter
• Thomas Paul Porter, MPT
• Jayne Scherf Prelosky, RPH
• John William Pullano, PT
• Laurie Lynn Pullano, MS, PT
• QLS Allegheny Valley LLC (Quality Life Services - Allegheny Valley)
• Erica Rabbin, MS, RDN, LDN
• Stephen Mark Rayburg, D.M.D.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Lower Burrell, PA
• Providers in Lower Burrell, PA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2013; 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.