1730579954 NPI number — BENCHMARK WELLINGTON SNF OPERATOR LLC

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 1730579954 NPI number — BENCHMARK WELLINGTON SNF OPERATOR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENCHMARK WELLINGTON SNF OPERATOR LLC
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:
WELLINGTON TERRACE AT HERSHEY'S MILL
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:
1730579954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1361 E BOOT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19380-5934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-653-1600
Provider Business Mailing Address Fax Number:
484-653-4200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1361 E BOOT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19380-5934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-653-1600
Provider Business Practice Location Address Fax Number:
484-653-4200
Provider Enumeration Date:
01/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GRAPE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRINCIPAL
Authorized Official Telephone Number:
781-489-7100

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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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