Provider Demographics
NPI:1053319418
Name:KITTANNING CARE CENTER, LLC
Entity Type:Organization
Organization Name:KITTANNING CARE CENTER, LLC
Other - Org Name:KITTANNING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:HENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-963-9150
Mailing Address - Street 1:209 SIGMA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2826
Mailing Address - Country:US
Mailing Address - Phone:412-963-9150
Mailing Address - Fax:412-963-6676
Practice Address - Street 1:120 KITTANNING CARE DR
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-4012
Practice Address - Country:US
Practice Address - Phone:724-545-2273
Practice Address - Fax:724-543-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA234802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018363240001Medicaid
PA1382OtherBLUE CROSS PROVIDER NO.
PA2058625OtherAETNA USHC PROVIDER NO.
PAV529P-1270OtherVETERANS ADMINISTRATION
PA000000111013OtherUNISON -MED PLUS 3 RIVERS
PA=========OtherCONSOL ENERGY HEALTHSCOPE
PA=========OtherGATEWAY
PA=========OtherBANKERS LIFE
PA=========OtherNABN MERITAIN
PA=========OtherUPMC
PA=========OtherCIGNA
PA000000111013OtherUNISON -MED PLUS 3 RIVERS
PA2058625OtherAETNA USHC PROVIDER NO.
PA=========OtherUMWA
PA=========OtherUNITED HEALTHCARE
PAV529P-1270OtherVETERANS ADMINISTRATION
PA0018363240001Medicaid
PA=========OtherAARP
PA=========OtherMUTUAL OF OMAHA