Mahoning Valley Convalescent Home, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

130202 Issued in PA

Legal business name

MAHONING VALLEY CONVALESCENT HOME, INC.

Doing business as

Mahoning Valley Nursing & Rehabilitation Center

Practice address

397 Hemlock Dr
Lehighton, PA 18235-9712

Phone

(570) 386-5522

Fax

(570) 386-3292

NPI assigned

Jul 21, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Michael Andrew Mickey

Title

President / C.E.O.

Phone

(570) 386-5522

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mahoning Valley Nursing & Rehabilitation Center Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598765489. Details of each certification follow.

• CCN 395480 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 395480

Legal name

MAHONING VALLEY CONVALESCENT HOME, INC.

Doing business as

MAHONING VALLEY NURSING & REHABILITATION CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 1, 1981

Last certification

Feb 21, 2025

Beds

142

Ownership / control type

Corporation

Organization structure

CorporationProprietary

Incorporated

Dec 26, 1972 in PA

Enrollment address

397 Hemlock Dr
Mahoning Valley Nursing and Rehabilitation Center
Lehighton, PA 18235-9640

Nursing home name

MAHONING OPERATING LLC

Listed as

Mahoning Operating LLCCCN 395480 · All quality measures

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

3 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Jan 1, 1981

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

142113.6 residents per day on average

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 4

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

Practitioners 1

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.

• Andrew Eric Graf

  • Internal Medicine Physician
  • Plymouth Meeting, PA
  • NPI 1316108269
  NPD (past)

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598765489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "397 HEMLOCK DR",
            "city": "LEHIGHTON",
            "state": "PA",
            "postal_code": "182359712",
            "telephone_number": "570-386-5522",
            "fax_number": "570-386-3292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "397 HEMLOCK DR",
            "city": "LEHIGHTON",
            "state": "PA",
            "postal_code": "182359712",
            "telephone_number": "570-386-5522",
            "fax_number": "570-386-3292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHONING VALLEY CONVALESCENT HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MICKEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT / C.E.O.",
        "authorized_official_telephone_number": "570-386-5522",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "130202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0007552770002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mahoning Valley Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Yingmo Lu
• Diane B Luedtke, CRNP
• Mahoning Operating LLC (MahoningPostAcuteNursing&Rehabilitation)
• Mahoning Valley Ambulance Association
• Mahoning Valley Ambulance Association, Inc.
• Edward Marchessault, PT
• Kimberly Marchessault, PT
• Cheryl L Marinchak, O.D.
• William M Markson, M.D.
• David Marouchoc, LSW

• Skilled Nursing Facility in Lehighton, PA
• Providers in Lehighton, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.