Provider Demographics
NPI:1801894712
Name:ST. JOHN LUTHERAN CARE CENTER
Entity type:Organization
Organization Name:ST. JOHN LUTHERAN CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:Q
Authorized Official - Last Name:DIGIROLAMO
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:724-742-2246
Mailing Address - Street 1:1323 FREEDOM RD
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5001
Mailing Address - Country:US
Mailing Address - Phone:724-776-1100
Mailing Address - Fax:724-776-0811
Practice Address - Street 1:500 WITTENBURG WAY
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046
Practice Address - Country:US
Practice Address - Phone:724-776-1100
Practice Address - Fax:724-776-0811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SENIORLIFE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-13
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
0621OtherBLUE CROSS
PA1007389300003Medicaid
0621OtherBLUE CROSS
PA0285310001Medicare NSC