Healthcare Provider Details

I. General information

NPI: 1801872320
Provider Name (Legal Business Name): PENNSYLVANIA LTC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 EDGE HILL RD
GLENSIDE PA
19038-3004
US

IV. Provider business mailing address

101 E STATE ST
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 215-886-1043
  • Fax: 215-886-2719
Mailing address:
  • Phone: 610-925-4436
  • Fax: 610-347-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number052702
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number052702
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number052702
License Number StatePA

VIII. Authorized Official

Name: JANE DROPESKEY
Title or Position: CORPORATE MANAGER
Credential:
Phone: 610-925-4321