Provider Demographics
NPI:1063445369
Name:SENIOR LIFE JOHNSTOWN, INC.
Entity Type:Organization
Organization Name:SENIOR LIFE JOHNSTOWN, INC.
Other - Org Name:SENIOR LIFE JOHNSTOWN
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 1:401 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15906-2716
Mailing Address - Country:US
Mailing Address - Phone:814-535-6000
Mailing Address - Fax:814-248-7902
Practice Address - Street 1:401 BROAD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15906-2716
Practice Address - Country:US
Practice Address - Phone:814-535-6000
Practice Address - Fax:814-248-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation