Cloverdale Personal Care Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

438900 Issued in PA

Legal business name

CLOVERDALE PERSONAL CARE HOME

Practice address

206 Westwood Ave
Masontown, PA 15461-1646

Phone

(724) 583-0620

Fax

(724) 583-0620

NPI assigned

Jun 12, 2008

Last updated

Jun 12, 2008By 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

Mrs. Carol Assad

Title

Owner

Phone

(724) 583-0620

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213228800000",
    "number": "1487814430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 WESTWOOD AVE",
            "city": "MASONTOWN",
            "state": "PA",
            "postal_code": "154611646",
            "telephone_number": "724-583-0620",
            "fax_number": "724-583-0620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 WESTWOOD AVE",
            "city": "MASONTOWN",
            "state": "PA",
            "postal_code": "154611646",
            "telephone_number": "724-583-0620",
            "fax_number": "724-583-0620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVERDALE PERSONAL CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-12",
        "last_updated": "2008-06-12",
        "status": "A",
        "authorized_official_last_name": "ASSAD",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "724-583-0620",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "PA",
            "license": "438900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; 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.