MEDICARE: ST. JOHN LUTHERAN CARE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility
2	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0621	OTHER		BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801894712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOHN LUTHERAN CARE CENTER

Provider Business Mailing Address
First Line	:	1323 FREEDOM RD
Second Line	:
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-5001
Country	:	US
Telephone Number	:	724-776-1100
Fax Number	:	724-776-0811

Provider Business Practice Location Address
First Line	:	500 WITTENBURG WAY
Second Line	:
City	:	MARS
State	:	PA
Zip	:	16046
Country	:	US
Telephone Number	:	724-776-1100
Fax Number	:	724-776-0811

Authorized Official
Title or Position	:	CFO
Name	:	JEFFREY CARRAWAY
Credential	:
Telephone Number	:	724-742-2246

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	10/08/2025

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