# PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** South Mountain Restoration Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295718039
- **Authorized official:** KATHY LIGHT (ADMINISTRATOR)
- **Authorized official phone:** (717) 772-2518

## Contact information

- **Practice address:** 10058 S MOUNTAIN RD, SOUTH MOUNTAIN, PA 17261-0900
- **Practice address phone:** (717) 749-4000
- **Practice address fax:** (717) 749-4071
- **Mailing address:** 10058 S MOUNTAIN RD, SOUTH MOUNTAIN, PA 17261-0900
- **Mailing address phone:** (717) 749-4000
- **Mailing address fax:** (717) 749-4071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | — |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/25/2005
- **Last updated:** 10/04/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100308518 | — | PA |