1023168283 NPI number — BALA NURSING & RET CNTR LTD PTRSHP FORD RD CORP

Table of content: (NPI 1023168283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023168283 NPI number — BALA NURSING & RET CNTR LTD PTRSHP FORD RD CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALA NURSING & RET CNTR LTD PTRSHP FORD RD CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023168283
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4001 FORD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19131-2833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-877-5400
Provider Business Mailing Address Fax Number:
215-871-3110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 FORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19131-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-877-5400
Provider Business Practice Location Address Fax Number:
215-871-3110
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
215-877-5400

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  041402 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0011856700001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: BLUE CROSS . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 19203 . This is a "SENIOR PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 606828 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 8133 . This is a "ELDER HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: KEYSTONE MERCY . This is a "1059563" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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