Healthcare Provider Details

I. General information

NPI: 1083399539
Provider Name (Legal Business Name): PENN GARDENS ADS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S BROAD ST
LANSDALE PA
19446-3819
US

IV. Provider business mailing address

320 S BROAD ST
LANSDALE PA
19446-3819
US

V. Phone/Fax

Practice location:
  • Phone: 267-647-6407
  • Fax: 267-642-9328
Mailing address:
  • Phone: 267-647-6407
  • Fax: 267-642-9328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KISHAN PATEL
Title or Position: MEMBER
Credential:
Phone: 732-516-8163