Provider Demographics
NPI:1598950412
Name:HIXENBAUGH'S PERSONAL CARE HOME
Entity Type:Organization
Organization Name:HIXENBAUGH'S PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-663-5911
Mailing Address - Street 1:327 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLAYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15323
Mailing Address - Country:US
Mailing Address - Phone:724-663-5911
Mailing Address - Fax:724-663-5290
Practice Address - Street 1:327 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15323
Practice Address - Country:US
Practice Address - Phone:724-663-5911
Practice Address - Fax:724-663-5290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA442500310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility