1467449322 NPI number — THE PRESBYTERIAN HOME AT 58TH STREET

Table of content: (NPI 1467449322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467449322 NPI number — THE PRESBYTERIAN HOME AT 58TH STREET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE PRESBYTERIAN HOME AT 58TH STREET
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:
6
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:
1467449322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 JOSHUA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE HILL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19444-2430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-834-1001
Provider Business Mailing Address Fax Number:
610-834-6556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2050 SOUTH 58TH STREET
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:
19143-5910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-724-2218
Provider Business Practice Location Address Fax Number:
215-724-6924
Provider Enumeration Date:
10/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HOFFMAN
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
610-260-1133

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  421902 , 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: 100777885 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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