Provider Demographics
NPI:1780668079
Name:GOOD SAMARITAN MEDICAL CENTER OF JOHNSTOWN
Entity Type:Organization
Organization Name:GOOD SAMARITAN MEDICAL CENTER OF JOHNSTOWN
Other - Org Name:GOOD SAMARITAN NURSING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NHA
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:TYRRELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN/MHA/NHA
Authorized Official - Phone:814-534-1934
Mailing Address - Street 1:1017 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4110
Mailing Address - Country:US
Mailing Address - Phone:814-534-1934
Mailing Address - Fax:814-534-1453
Practice Address - Street 1:1017 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4110
Practice Address - Country:US
Practice Address - Phone:814-534-1934
Practice Address - Fax:814-534-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA291702-01314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0602OtherBLUE CROSS
PA1007731330019Medicaid
PA0602OtherBLUE CROSS