Healthcare Provider Details

I. General information

NPI: 1063445369
Provider Name (Legal Business Name): SENIOR LIFE JOHNSTOWN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BROAD ST
JOHNSTOWN PA
15906-2716
US

IV. Provider business mailing address

401 BROAD ST
JOHNSTOWN PA
15906-2716
US

V. Phone/Fax

Practice location:
  • Phone: 814-535-6000
  • Fax: 814-248-7902
Mailing address:
  • Phone: 814-535-6000
  • Fax: 814-248-7902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HERBERT H HENNELL
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 412-963-9150