West Haven Manor, LP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

235502 Issued in PA

Legal business name

WEST HAVEN MANOR, LP

Practice address

151 Goodview Drive
Apollo, PA 15613-8527

Phone

(724) 727-3451

Fax

(724) 727-2432

NPI assigned

Oct 17, 2005

Last updated

Aug 14, 2014By 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

Steven D Tack, NHA

Title

Ceo

Phone

(724) 431-0770

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407974400000",
    "number": "1700875382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 GOODVIEW DRIVE",
            "city": "APOLLO",
            "state": "PA",
            "postal_code": "156138527",
            "telephone_number": "724-727-3451",
            "fax_number": "724-727-2432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 GOODVIEW DRIVE",
            "city": "APOLLO",
            "state": "PA",
            "postal_code": "156138527",
            "telephone_number": "724-727-3451",
            "fax_number": "724-727-2432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST HAVEN MANOR, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-17",
        "last_updated": "2014-08-14",
        "status": "A",
        "authorized_official_last_name": "TACK",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "724-431-0770",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "235502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1024978350001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Apollo, PA
• Providers in Apollo, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; 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.