Basic Information
| Provider Information | |||||||||
| NPI: | 1518461565 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GUARDIAN ELDER CARE AT BEAVER FALLS LLC | ||||||||
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| OtherOrganizationName: | BEAVER VALLEY HEALTHCARE AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8796 ROUTE 219 | ||||||||
| Address2: | |||||||||
| City: | BROCKWAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158246010 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 257 GEORGETOWN RD | ||||||||
| Address2: | |||||||||
| City: | BEAVER FALLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150109740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248468200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2018 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| AuthorizedOfficialLastName: | EPERESI | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8142651164 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 103496117-0001 | 05 | PA | MEDICAID |