Healthcare Provider Details

I. General information

NPI: 1487726089
Provider Name (Legal Business Name): DELANCO HEALTHCARE BELMONT & PARKSIDE LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W GIRARD AVE
PHILADELPHIA PA
19104-3434
US

IV. Provider business mailing address

4400 W GIRARD AVE
PHILADELPHIA PA
19104-3434
US

V. Phone/Fax

Practice location:
  • Phone: 215-477-1170
  • Fax: 215-879-0180
Mailing address:
  • Phone: 215-477-1170
  • Fax: 215-879-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number193902
License Number StatePA

VIII. Authorized Official

Name: NATHANIEL GLENN JR.
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 215-477-1170