Healthcare Provider Details

I. General information

NPI: 1548336621
Provider Name (Legal Business Name): MAIN LINE REHABILITATION ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 EXTON CMNS
EXTON PA
19341-2446
US

IV. Provider business mailing address

668 EXTON CMNS
EXTON PA
19341-2446
US

V. Phone/Fax

Practice location:
  • Phone: 610-280-0180
  • Fax: 610-280-0192
Mailing address:
  • Phone: 610-280-0180
  • Fax: 610-280-0192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1000009070001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: JAMES L CARROLL
Title or Position: DIRECTOR
Credential:
Phone: 610-280-0180