Active NPI
County of Indiana
- Skilled Nursing Facility
- Indiana, PA
National Provider Identifier
1942283528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 090102
- Legal business name
- COUNTY OF INDIANA
- Practice address
- 1675 Saltsburg Ave
Indiana, PA 15701-3573 - Phone
- (724) 465-3900
- Fax
- (724) 465-2013
- NPI assigned
- Nov 28, 2005
- Organization subpart
- Yes
- Parent organization
- COUNTY OF INDIANA
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Kimberly Cobaugh, RNC, MSN, NHA
- Title
- Administrator
- Phone
- (724) 465-3900
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 090102 | PA | Primary |
Addresses
Primary practice location
1675 Saltsburg Ave
Indiana, PA 15701-3573
Mailing address
1675 Saltsburg Ave
Indiana, PA 15701-3573
Phone (724) 465-3900
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 643 | Other | PA | BLUE CORSS |
| 6433 | Other | PA | BLUE CROSS |
| 1007463790005 | Medicaid | PA |
Other names 1
- The Communities at Indian Haven
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100125000375 | PA | Part A Provider - Skilled Nursing Facility | 1658413901 | Practice locations: Indiana, PA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1942283528. Details of each certification follow.
Skilled nursing facility certification: CCN 395778
- Legal name
- COUNTY OF INDIANA
- Doing business as
- THE COMMUNITIES AT INDIAN HAVEN
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Dec 1, 1988
- Last certification
- Feb 5, 2025
- Beds
- 108
- Ownership / control type
- County
- Organization structure
- Government
- Incorporated
- in PA
- Enrollment address
- 1675 Saltsburg Avenue
Indiana, PA 15701-3573 - Nursing home name
- COMMUNITIES AT INDIAN HAVEN,
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Communities at Indian Haven,
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Government - County
- Certified
- Dec 1, 1988
- Medicare certification status
- Active
- Certified beds
- 108
- Penalties (3 years)
- 1
National Provider Directory
National Provider Directory- Part of
- County of Indiana
Ownership & related parties
All disclosed owners & managing parties 5
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Sherene Hess | Corporate Officer | Jan 1, 2016 | 33% |
| Robin Gorman | Corporate Officer | Jan 1, 2020 | 33.3% |
| Affinity Health Services | Operational/Managerial Control | Dec 19, 1996 | 100% |
| Robert Michael Keith | Corporate Officer | Jan 1, 2020 | 33.3% |
| Kimberly CHI | Contracted Managing Employee | Aug 6, 2021 | 100% |
Facilities with the same owner 2
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Skilled Nursing Facility
- Scranton, PA
- NPI 1235137472
Affinity Health Services
Practitioners & affiliated clinicians
Practitioners 3
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.
-
- Legal Medicine
- Indiana, PA
- NPI 1871512376
-
- Internal Medicine Physician
- Blairsville, PA
- NPI 1952367401
-
- Internal Medicine Physician
- Blairsville, PA
- NPI 1114983616
Affiliated clinicians 5
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": "1133136000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1450224000000",
"number": "1942283528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1675 SALTSBURG AVE",
"city": "INDIANA",
"state": "PA",
"postal_code": "157013573",
"telephone_number": "724-465-3900",
"fax_number": "724-465-2013"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1675 SALTSBURG AVE",
"city": "INDIANA",
"state": "PA",
"postal_code": "157013573",
"telephone_number": "724-465-3900",
"fax_number": "724-465-2013"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COUNTY OF INDIANA",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COUNTY OF INDIANA",
"enumeration_date": "2005-11-28",
"last_updated": "2015-12-16",
"status": "A",
"authorized_official_last_name": "COBAUGH",
"authorized_official_first_name": "KIMBERLY",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "724-465-3900",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "RNC, MSN, NHA"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "PA",
"license": "090102",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CORSS",
"identifier": "643",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "6433",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007463790005",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "The Communities at Indian Haven",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Indiana, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2015; 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.