Healthcare Provider Details

I. General information

NPI: 1619829074
Provider Name (Legal Business Name): OLDE MAIN OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 BELMONT AVE
PHILADELPHIA PA
19131-1648
US

IV. Provider business mailing address

2101 BELMONT AVE
PHILADELPHIA PA
19131-1648
US

V. Phone/Fax

Practice location:
  • Phone: 215-878-3600
  • Fax:
Mailing address:
  • Phone: 215-878-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: MINDEE POSEN
Title or Position: MEDICARE ADMINISTRATION OFFICER
Credential:
Phone: 845-825-2217