Provider Demographics
NPI:1942283528
Name:COUNTY OF INDIANA
Entity type:Organization
Organization Name:COUNTY OF INDIANA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:COBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RNC, MSN, NHA
Authorized Official - Phone:724-465-3900
Mailing Address - Street 1:1675 SALTSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3573
Mailing Address - Country:US
Mailing Address - Phone:724-465-3900
Mailing Address - Fax:724-465-2013
Practice Address - Street 1:1675 SALTSBURG AVE
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3573
Practice Address - Country:US
Practice Address - Phone:724-465-3900
Practice Address - Fax:724-465-2013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF INDIANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-28
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA090102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA643OtherBLUE CORSS
PA6433OtherBLUE CROSS
PA1007463790005Medicaid
PA6433OtherBLUE CROSS
PA395778Medicare UPIN
PA1007463790005Medicaid