1720041874 NPI number — GREEN ACRES REHABILITATION & NURSING CENTER

Table of content: (NPI 1720041874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720041874 NPI number — GREEN ACRES REHABILITATION & NURSING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREEN ACRES REHABILITATION & NURSING CENTER
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:
1720041874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 IVYBROOK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IVYLAND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18974-1700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-357-6055
Provider Business Mailing Address Fax Number:
215-357-6968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 IVY HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYNDMOOR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19150-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-357-6055
Provider Business Practice Location Address Fax Number:
215-357-6968
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SEGAL
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-357-6055

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  591902 , 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: 13111 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25206 . This is a "GREEN ACRES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0095121400001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1027618 . This is a "KEYSTONE MERCY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005891000 . This is a "KEYSTONE 65" identifier . This identifiers is of the category "OTHER".
  • Identifier: PA235 . This is a "ELDERHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005891000 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0095121401 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com