Healthcare Provider Details

I. General information

NPI: 1134123730
Provider Name (Legal Business Name): CATHEDRAL VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E CATHEDRAL RD
PHILADELPHIA PA
19128-1933
US

IV. Provider business mailing address

1 TRINITY DR E SUITE 201
DILLSBURG PA
17019-8522
US

V. Phone/Fax

Practice location:
  • Phone: 215-487-1330
  • Fax: 215-984-8689
Mailing address:
  • Phone: 717-502-8840
  • Fax: 717-502-8842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030402
License Number StatePA

VIII. Authorized Official

Name: MRS. DONNA CASNER
Title or Position: CONTROLLER
Credential:
Phone: 717-502-8922