Healthcare Provider Details

I. General information

NPI: 1285783852
Provider Name (Legal Business Name): KENSINGTON HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 DIAMOND ST
PHILADELPHIA PA
19122-1721
US

IV. Provider business mailing address

136 DIAMOND ST
PHILADELPHIA PA
19122-1721
US

V. Phone/Fax

Practice location:
  • Phone: 215-426-8100
  • Fax: 215-965-2344
Mailing address:
  • Phone: 215-426-8100
  • Fax: 215-965-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number39D0200054
License Number StatePA

VIII. Authorized Official

Name: MS. EILEEN HAUSE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.B.A.
Phone: 215-426-8100