Provider Demographics
NPI:1700881992
Name:PRESBYTERIAN SENIORCARE
Entity type:Organization
Organization Name:PRESBYTERIAN SENIORCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:E
Authorized Official - Last Name:MANGENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-826-6081
Mailing Address - Street 1:1215 HULTON RD
Mailing Address - Street 2:
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-1135
Mailing Address - Country:US
Mailing Address - Phone:412-826-6032
Mailing Address - Fax:412-826-6061
Practice Address - Street 1:1215 HULTON RD
Practice Address - Street 2:
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-1135
Practice Address - Country:US
Practice Address - Phone:412-826-6032
Practice Address - Fax:412-826-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAHP416587L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007769120001Medicaid