Healthcare Provider Details

I. General information

NPI: 1083611487
Provider Name (Legal Business Name): NAZARETH HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 HOLME AVE
PHILADELPHIA PA
19152-2007
US

IV. Provider business mailing address

2601 HOLME AVE
PHILADELPHIA PA
19152-2007
US

V. Phone/Fax

Practice location:
  • Phone: 215-335-6000
  • Fax: 215-335-6303
Mailing address:
  • Phone: 215-335-6000
  • Fax: 215-335-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number400302
License Number StatePA

VIII. Authorized Official

Name: MR. DAVID A. WAJDA
Title or Position: CHIEF FINANCIAL OFFICER, VP FINANCE
Credential:
Phone: 215-335-6043