Healthcare Provider Details

I. General information

NPI: 1548268840
Provider Name (Legal Business Name): DUNWOODY VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W CHESTER PIKE
NEWTOWN SQUARE PA
19073-4101
US

IV. Provider business mailing address

3500 W CHESTER PIKE
NEWTOWN SQUARE PA
19073-4101
US

V. Phone/Fax

Practice location:
  • Phone: 610-359-4400
  • Fax: 610-359-4498
Mailing address:
  • Phone: 610-359-4400
  • Fax: 610-359-4498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number041602
License Number StatePA

VIII. Authorized Official

Name: MR. ROBERT L. SUPPER
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 610-359-4426