Healthcare Provider Details

I. General information

NPI: 1760622161
Provider Name (Legal Business Name): PHHA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 OLD WEST CHESTER PIKE
HAVERTOWN PA
19083-2712
US

IV. Provider business mailing address

7444 LONG AVE
SKOKIE IL
60077-3214
US

V. Phone/Fax

Practice location:
  • Phone: 610-449-8600
  • Fax:
Mailing address:
  • Phone: 847-329-4100
  • Fax: 847-329-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MARALEE RUNGE
Title or Position: OFFICE MANAGER
Credential:
Phone: 847-329-4100