Healthcare Provider Details

I. General information

NPI: 1164419909
Provider Name (Legal Business Name): BAPTIST HOME OF PHILADELPHIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 ROOSEVELT BLVD
PHILADELPHIA PA
19152-2006
US

IV. Provider business mailing address

8301 ROOSEVELT BLVD
PHILADELPHIA PA
19152-2006
US

V. Phone/Fax

Practice location:
  • Phone: 215-624-7575
  • Fax: 215-624-7020
Mailing address:
  • Phone: 215-624-7575
  • Fax: 215-624-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number020202
License Number StatePA

VIII. Authorized Official

Name: LISA M SOFIA
Title or Position: COO / ADMINISTRATOR
Credential: BSN, NHA
Phone: 215-624-7575