Provider Demographics
NPI:1184599748
Name:REBECCA RESIDENCE
Entity type:Organization
Organization Name:REBECCA RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-352-1571
Mailing Address - Street 1:207 OTTAWA ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2337
Mailing Address - Country:US
Mailing Address - Phone:814-266-8621
Mailing Address - Fax:814-266-1641
Practice Address - Street 1:207 OTTAWA ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2337
Practice Address - Country:US
Practice Address - Phone:814-266-8621
Practice Address - Fax:814-266-1641
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REBECCA RESIDENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-06
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility