Healthcare Provider Details

I. General information

NPI: 1164530366
Provider Name (Legal Business Name): CLIVEDEN- MAPLEWOOD CONVALESCENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W SCHOOL HOUSE LN
PHILADELPHIA PA
19144-3348
US

IV. Provider business mailing address

6950 GERMANTOWN AVE
PHILADELPHIA PA
19119-2120
US

V. Phone/Fax

Practice location:
  • Phone: 215-951-7630
  • Fax: 215-844-8004
Mailing address:
  • Phone: 215-951-7630
  • Fax: 215-844-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DONALD LEVESQUE
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 215-951-4596