Provider Demographics
NPI:1235131418
Name:INDIANA SKILLED NURSING INC
Entity type:Organization
Organization Name:INDIANA SKILLED NURSING INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-349-5300
Mailing Address - Street 1:1515 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-4702
Mailing Address - Country:US
Mailing Address - Phone:724-349-5300
Mailing Address - Fax:724-349-5379
Practice Address - Street 1:1515 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-4702
Practice Address - Country:US
Practice Address - Phone:724-349-5300
Practice Address - Fax:724-349-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0331314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001324140005Medicaid
PA1235131418OtherNPI
PA395702Medicare ID - Type Unspecified
PA1185500001Medicare NSC