Provider Demographics
NPI:1710982392
Name:HOSPITALITY CARE CENTER OF HERMITAGE, INC.
Entity Type:Organization
Organization Name:HOSPITALITY CARE CENTER OF HERMITAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:LEIST
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:724-342-5279
Mailing Address - Street 1:3726 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3409
Mailing Address - Country:US
Mailing Address - Phone:724-342-5279
Mailing Address - Fax:724-981-1271
Practice Address - Street 1:3726 E STATE ST
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3409
Practice Address - Country:US
Practice Address - Phone:724-342-5279
Practice Address - Fax:724-981-1271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA011302313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008972720001Medicaid
PA395232Medicare Oscar/Certification