Healthcare Provider Details

I. General information

NPI: 1609572122
Provider Name (Legal Business Name): KENSINGTON HOSPITAL MEDICAL REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 DIAMOND ST
PHILADELPHIA PA
19122-1797
US

IV. Provider business mailing address

136 DIAMOND ST
PHILADELPHIA PA
19122-1797
US

V. Phone/Fax

Practice location:
  • Phone: 215-426-8100
  • Fax: 267-861-6410
Mailing address:
  • Phone: 215-426-8100
  • Fax: 267-861-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MARIA ZUKOWSKI
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 215-426-8100