Provider Demographics
NPI:1548280076
Name:LAS GERIATRIC CARE SERVICES, INC.
Entity type:Organization
Organization Name:LAS GERIATRIC CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FENOGLIETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-776-1100
Mailing Address - Street 1:1323 FREEDOM RD
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5001
Mailing Address - Country:US
Mailing Address - Phone:724-776-1100
Mailing Address - Fax:724-776-0811
Practice Address - Street 1:100 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-3629
Practice Address - Country:US
Practice Address - Phone:724-378-5400
Practice Address - Fax:724-302-2093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA428163Medicare ID - Type UnspecifiedPHYSICIAN PRACTICE