NPIMap

Organization Active NPI

Pennsylvania Department of Human Services

Doing business as South Mountain Restoration Center

  • Skilled Nursing Facility
  • South Mountain, PA
National Provider Identifier
1295718039
Registry record updated Oct 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Doing business as
South Mountain Restoration Center
Practice address
10058 S Mountain Rd
South Mountain, PA 17261-0900
Phone
(717) 749-4000
Fax
(717) 749-4071
NPI assigned
Nov 25, 2005
Last updated
Oct 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2021

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

Authorized official

Name
Kathy Light
Title
Administrator
Phone
(717) 772-2518

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

10058 S Mountain Rd
South Mountain, PA 17261-0900

Mailing address

10058 S Mountain Rd
South Mountain, PA 17261-0900
Phone (717) 749-4000

Other identifiers 1

IdentifierTypeStateIssuer
100308518MedicaidPA

Other names 1

  • South Mountain Restoration Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040604000167 PA Part B Supplier - Clinic/Group Practice 0547168064 Receives reassigned benefits from 5 practitioners
Practice locations: South Mountain, PA
O20061016000275 PA Part A Provider - Skilled Nursing Facility 0547168064 Practice locations: South Mountain, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295718039. Details of each certification follow.

Skilled nursing facility certification: CCN 395583

Legal name
PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES
Doing business as
SOUTH MOUNTAIN RESTORATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1985
Last certification
Oct 3, 2024
Beds
159
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
10058 South Mountain Rd
South Mountain Restoration Center
South Mountain, PA 17261-0999
Nursing home name
SOUTH MOUNTAIN RESTORATION CEN

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
South Mountain Restoration CenCCN 395583 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Government - State
Certified
Jul 1, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
15989.1 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D0716423South Mountain Restoration Center10058 South Mountain Road, South Mountain, PA 17261Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Polk Center16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Martin Hudzinski Individual Operational/Managerial ControlMedical Director Jan 6, 2014
Adp of the SNF Jan 6, 2014
Pennsylvania Department of Human Services Organization, South Mountain, PA Adp of the SNF Sep 15, 2025
Krista Delacruz Individual Operational/Managerial ControlChief Social Rehabilitative Exec Jul 9, 2022
Adp of the SNF Jul 9, 2022
Melinda Commerer Individual Operational/Managerial ControlDirector of Nursing Jan 1, 2022
Adp of the SNF Jan 1, 2022
Bradley J Hyde Individual Operational/Managerial ControlChief Operating Officer Sep 24, 2016
Adp of the SNF Sep 24, 2016
Shane L Sloat Individual Operational/Managerial Control Feb 15, 2025
Adp of the SNF Feb 15, 2025

Owners & managing parties with NPI records 10

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Warren State HospitalNorth Warren, PA, CCN 394016 Hospital Operational/Managerial Control Jan 1, 1966
Wernersville State HospitalWernersville, PA, CCN 394014 Hospital Operational/Managerial Control Feb 10, 2007
Danville State HospitalDanville, PA, CCN 394004 Hospital Operational/Managerial Control Dec 31, 2011
Norristown State HospitalNorristown, PA, CCN 394001 Hospital Operational/Managerial Control Jul 12, 1966
Pennsylvania Department of Human ServicesClarks Summit, PA, CCN 394012 Hospital Operational/Managerial Control Dec 24, 2014
Torrance State HospitalTorrance, PA, CCN 394026 Hospital Operational/Managerial Control (100%) Jul 1, 1966

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633305600000",
    "number": "1295718039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10058 S MOUNTAIN RD",
            "city": "SOUTH MOUNTAIN",
            "state": "PA",
            "postal_code": "172610900",
            "telephone_number": "717-749-4000",
            "fax_number": "717-749-4071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10058 S MOUNTAIN RD",
            "city": "SOUTH MOUNTAIN",
            "state": "PA",
            "postal_code": "172610900",
            "telephone_number": "717-749-4000",
            "fax_number": "717-749-4071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNSYLVANIA DEPARTMENT OF HUMAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-25",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A",
        "authorized_official_last_name": "LIGHT",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "717-772-2518"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100308518",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Mountain Restoration Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Mountain Restoration Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Mountain, PA

Sources for this page

Verify at the official NPI Registry.