Healthcare Provider Details

I. General information

NPI: 1982680633
Provider Name (Legal Business Name): SAINT MARTHA MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 MANOR AVE
DOWNINGTOWN PA
19335-2545
US

IV. Provider business mailing address

470 MANOR AVE
DOWNINGTOWN PA
19335-2545
US

V. Phone/Fax

Practice location:
  • Phone: 610-873-8490
  • Fax: 610-873-5684
Mailing address:
  • Phone: 610-873-8490
  • Fax: 610-873-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number457402
License Number StatePA

VIII. Authorized Official

Name: MR. MICHAEL CZEKNER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 215-368-0900