# JOHN XXIII HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740282144
- **Authorized official:** MR. KIRK L HAWTHORNE NHA (ADMINISTRATOR)
- **Authorized official phone:** (724) 981-3200

## Contact information

- **Practice address:** 2250 SHENANGO VALLEY FWY, HERMITAGE, PA 16148-2549
- **Practice address phone:** (724) 981-3200
- **Practice address fax:** (724) 981-1677
- **Mailing address:** 2250 SHENANGO VALLEY FWY, HERMITAGE, PA 16148-2549
- **Mailing address phone:** (724) 981-3200
- **Mailing address fax:** (724) 981-1677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 360202 | PA | Yes |

## Other

- **Enumeration date:** 08/15/2005
- **Last updated:** 08/01/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0007473280001 | — | PA |
| 01 | — | 0994 | HIGHMARK SECURITY BLUE | PA |