Healthcare Provider Details

I. General information

NPI: 1922056076
Provider Name (Legal Business Name): SHANNONDELL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 SHANNONDELL DR
AUDUBON PA
19403-5684
US

IV. Provider business mailing address

5000 SHANNONDELL DR
AUDUBON PA
19403-5684
US

V. Phone/Fax

Practice location:
  • Phone: 610-728-5400
  • Fax: 610-382-6835
Mailing address:
  • Phone: 610-728-5400
  • Fax: 610-382-6835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberA00010
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number17580201
License Number StatePA

VIII. Authorized Official

Name: MR. DAVID S. RITTENHOUSE
Title or Position: PRESIDENT
Credential:
Phone: 610-631-1100