Healthcare Provider Details

I. General information

NPI: 1629424601
Provider Name (Legal Business Name): HCR MANORCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E LANCASTER AVE
DEVON PA
19333
US

IV. Provider business mailing address

235 E LANCASTER AVE
DEVON PA
19333
US

V. Phone/Fax

Practice location:
  • Phone: 610-688-8080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberTE1003753
License Number StatePA

VIII. Authorized Official

Name: ANGELA SCHATZ
Title or Position: DOR
Credential: OTR
Phone: 215-514-7480