MEDICARE: ENLIVE OPERATOR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1619603990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENLIVE OPERATOR LLC

Provider Business Mailing Address
First Line	:	2600 BELMONT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2713
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 BELMONT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2713
Country	:	US
Telephone Number	:	215-878-5600
Fax Number	:

Authorized Official
Title or Position	:	MEDICARE ADMINISTRATION OFFICER
Name	:	MINDEE POSEN
Credential	:
Telephone Number	:	845-825-2217

Provider Enumeration Date	:	07/28/2022
Last Update Date	:	08/18/2022

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Directions to “ENLIVE OPERATOR LLC ” Practice Location

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