Provider Demographics
NPI:1821096801
Name:KINKORA PYTHIAN HOME
Entity Type:Organization
Organization Name:KINKORA PYTHIAN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HIMMELBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA, MSW,BA
Authorized Official - Phone:717-834-4887
Mailing Address - Street 1:25 COVE RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANNON
Mailing Address - State:PA
Mailing Address - Zip Code:17020-9514
Mailing Address - Country:US
Mailing Address - Phone:717-834-4887
Mailing Address - Fax:717-834-6622
Practice Address - Street 1:25 COVE RD
Practice Address - Street 2:
Practice Address - City:DUNCANNON
Practice Address - State:PA
Practice Address - Zip Code:17020-9514
Practice Address - Country:US
Practice Address - Phone:717-834-4887
Practice Address - Fax:717-834-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA110902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007575300001Medicaid
PA395915Medicare ID - Type Unspecified