1134164031 NPI number — GENESIS ELDERCARE CENTERS-PENNSBURG, INC.

Table of content: (NPI 1134164031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134164031 NPI number — GENESIS ELDERCARE CENTERS-PENNSBURG, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS ELDERCARE CENTERS-PENNSBURG, 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:
PENNSBURG MANOR
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:
1134164031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNETT SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19348-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-925-4436
Provider Business Mailing Address Fax Number:
610-925-4351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 MACOBY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENNSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18073-1112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-679-8076
Provider Business Practice Location Address Fax Number:
215-679-3117
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DROPESKEY
Authorized Official First Name:
JANE
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE MANAGER
Authorized Official Telephone Number:
610-925-4231

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  162402 , 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: 10085 . This is a "ELDERHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 255073 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 317126 . This is a "US FAMILY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005772000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1073197 . This is a "KEYSTONE MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005772000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0019531600001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2160447 . This is a "AETNA-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35996 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".




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