1265474910 NPI number — ACTS RETIREMENT-LIFE COMMUNITIES INC

Table of content: (NPI 1265474910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265474910 NPI number — ACTS RETIREMENT-LIFE COMMUNITIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTS RETIREMENT-LIFE COMMUNITIES INC
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:
GRANITE FARMS ESTATES WILLOWBROOKE COURT AT GRANITE FARMS
Provider Other Organization Name Type Code:
3
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:
1265474910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 DELAWARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19034-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-661-8330
Provider Business Mailing Address Fax Number:
215-661-8316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1343 W BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
GRANITE FARMS ESTATES
Provider Business Practice Location Address City Name:
MEDIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063-5519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-358-3440
Provider Business Practice Location Address Fax Number:
610-358-9660
Provider Enumeration Date:
06/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AHERN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP, CFO
Authorized Official Telephone Number:
215-661-8330

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  073602 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 073602 , 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: 0005897000 . This is a "PERSONAL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 111679 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 47562 . This is a "PARTNERS MEDICARE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005897000 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 911028 . This is a "KEYSTONE" identifier . This identifiers is of the category "OTHER".