1801894712 NPI number — ST. JOHN LUTHERAN CARE CENTER

Table of content: (NPI 1801894712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801894712 NPI number — ST. JOHN LUTHERAN CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. JOHN LUTHERAN CARE CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801894712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1323 FREEDOM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANBERRY TOWNSHIP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16066-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-776-1100
Provider Business Mailing Address Fax Number:
724-776-0811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 WITTENBURG WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-776-1100
Provider Business Practice Location Address Fax Number:
724-776-0811
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DIGIROLAMO
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Q
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
724-742-2246

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0621 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007389300003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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