1396728366 NPI number — LUTHERAN COMMUNITY AT TELFORD

Table of content: (NPI 1396728366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396728366 NPI number — LUTHERAN COMMUNITY AT TELFORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN COMMUNITY AT TELFORD
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:
1396728366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 LUTHERAN HOME DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TELFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18969-1787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-723-9819
Provider Business Mailing Address Fax Number:
215-723-3623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 LUTHERAN HOME DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TELFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18969-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-723-9819
Provider Business Practice Location Address Fax Number:
215-723-3623
Provider Enumeration Date:
11/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHRAGER
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
NATALIE
Authorized Official Title or Position:
NURSING HOME ADMINISTRATOR
Authorized Official Telephone Number:
215-723-9819

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  144220 , 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: 124502 , 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: 0007503880001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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