Organization
JOHN XXIII HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIRK L HAWTHORNE NHA (ADMINISTRATOR)
(724) 981-3200
Entity
Organization
Contact information
Practice address
2250 SHENANGO VALLEY FWY, HERMITAGE, PA 16148-2549
(724) 981-3200
(724) 981-1677
Mailing address
2250 SHENANGO VALLEY FWY, HERMITAGE, PA 16148-2549
(724) 981-3200
(724) 981-1677
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
360202
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007473280001
—
PA
01
—
0994
HIGHMARK SECURITY BLUE
PA
Enumeration date
08/15/2005
Last updated
08/01/2012
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