Provider Demographics
NPI:1518919778
Name:WESBURY UNITED METHODIST COMMUNITY
Entity type:Organization
Organization Name:WESBURY UNITED METHODIST COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAGEOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:814-332-9000
Mailing Address - Street 1:31 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-9440
Mailing Address - Country:US
Mailing Address - Phone:814-332-9000
Mailing Address - Fax:814-333-2163
Practice Address - Street 1:31 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-9440
Practice Address - Country:US
Practice Address - Phone:814-332-9000
Practice Address - Fax:814-333-2163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA990902314000000X
PA447730310400000X
PA2324311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009824080002Medicaid
PA0678OtherBLUE CROSS
PA0678OtherBLUE CROSS