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Organization

PENNSYLVANIA PACE, INC.

Active
Other names
Senior life Johnstown
Organization subpart
No

Provider details

NPI number
Authorized official
MR. HERBERT H HENNELL (DIRECTOR OF REIMBURSEMENT)
(412) 963-9150
Entity
Organization

Contact information

Practice address
401 BROAD ST, JOHNSTOWN, PA 15906-2716
(814) 535-6000
(814) 248-7902
Mailing address
209 SIGMA DR, PITTSBURGH, PA 15238-2826
(412) 963-9150
(412) 963-6676

Taxonomy

Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
PA
253Z00000X
In Home Supportive Care Agency
9963601
PA
261QA0600X
Adult Day Care Clinic/Center
104070
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
101362553-0001
PA
01
H3925
MEDICARE AGREEMENT NUMBER
PA
Enumeration date
01/17/2007
Last updated
09/26/2016
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