Healthcare Provider Details

I. General information

NPI: 1801894712
Provider Name (Legal Business Name): ST. JOHN LUTHERAN CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WITTENBURG WAY
MARS PA
16046
US

IV. Provider business mailing address

1323 FREEDOM RD
CRANBERRY TOWNSHIP PA
16066-5001
US

V. Phone/Fax

Practice location:
  • Phone: 724-776-1100
  • Fax: 724-776-0811
Mailing address:
  • Phone: 724-776-1100
  • Fax: 724-776-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0621
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS
# 2
Identifier1007389300003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: JEFFREY CARRAWAY
Title or Position: CFO
Credential:
Phone: 724-742-2246