1467744383 NPI number — TUCKER HOUSE NURSING AND REHABILITATION CENTER PA, LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467744383 NPI number — TUCKER HOUSE NURSING AND REHABILITATION CENTER PA, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TUCKER HOUSE NURSING AND REHABILITATION CENTER PA, LP
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:
1467744383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1922 GREENSPRING DR
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
TIMONIUM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-7603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-923-2415
Provider Business Mailing Address Fax Number:
410-923-2416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 WALLACE ST
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:
19123-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-923-2415
Provider Business Practice Location Address Fax Number:
410-923-2416
Provider Enumeration Date:
05/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MCADAMS
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF ACCOUNTS RECEIVABLE
Authorized Official Telephone Number:
410-923-2415

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  369402 , 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)





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