Provider Demographics
NPI:1902806854
Name:CHURCH OF THE BRETHREN HOME
Entity Type:Organization
Organization Name:CHURCH OF THE BRETHREN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:814-467-5505
Mailing Address - Street 1:277 HOFFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-2369
Mailing Address - Country:US
Mailing Address - Phone:814-467-5505
Mailing Address - Fax:814-361-6412
Practice Address - Street 1:277 HOFFMAN AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-2369
Practice Address - Country:US
Practice Address - Phone:814-467-5505
Practice Address - Fax:814-361-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007520410002Medicaid
PA0620OtherHIGHMARK BLUE CROSS
PA1446138OtherUNITED MINE WORKERS
PA1446138OtherUNITED MINE WORKERS
PA395090Medicare Oscar/Certification