Pennsylvania Pace, Inc.

Primary specialty

PACE Provider OrganizationTaxonomy code 251T00000X

Legal business name

PENNSYLVANIA PACE, INC.

Practice address

401 Broad St
Johnstown, PA 15906-2716

Phone

(814) 535-6000

Fax

(814) 248-7902

NPI assigned

Jan 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Herbert H Hennell

Title

Director of Reimbursement

Phone

(412) 963-9150

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Senior life Johnstown Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474848000000",
    "number": "1265584833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 SIGMA DR",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152382826",
            "telephone_number": "412-963-9150",
            "fax_number": "412-963-6676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 BROAD ST",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159062716",
            "telephone_number": "814-535-6000",
            "fax_number": "814-248-7902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNSYLVANIA PACE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2016-09-26",
        "status": "A",
        "authorized_official_last_name": "HENNELL",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "DIRECTOR OF REIMBURSEMENT",
        "authorized_official_telephone_number": "412-963-9150",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "PA",
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "PA",
            "license": "9963601",
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "PA",
            "license": "104070",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101362553-0001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE AGREEMENT NUMBER",
            "identifier": "H3925",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Senior life Johnstown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Johnstown, PA
• PACE Provider Organization in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.