Provider Demographics
NPI:1982697397
Name:JHA MARKLEYSBURG INC
Entity type:Organization
Organization Name:JHA MARKLEYSBURG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:MITTLEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-619-0866
Mailing Address - Street 1:5253 NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:MARKLEYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15459-1025
Mailing Address - Country:US
Mailing Address - Phone:724-329-5545
Mailing Address - Fax:724-329-1068
Practice Address - Street 1:5253 NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:MARKLEYSBURG
Practice Address - State:PA
Practice Address - Zip Code:15459-1025
Practice Address - Country:US
Practice Address - Phone:724-329-5545
Practice Address - Fax:724-329-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA060602313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1696395Medicaid
PA1696395Medicaid