Healthcare Provider Details

I. General information

NPI: 1477537827
Provider Name (Legal Business Name): PHILADELPHIA PROTESTANT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 TABOR RD
PHILADELPHIA PA
19111-5332
US

IV. Provider business mailing address

6500 TABOR RD
PHILADELPHIA PA
19111-5332
US

V. Phone/Fax

Practice location:
  • Phone: 215-697-8000
  • Fax: 215-697-8018
Mailing address:
  • Phone: 215-697-8000
  • Fax: 215-697-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number144500
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number681002
License Number StatePA

VIII. Authorized Official

Name: MR. DAVID WICKER
Title or Position: CFO
Credential:
Phone: 215-697-8357