Healthcare Provider Details

I. General information

NPI: 1225036544
Provider Name (Legal Business Name): MARWOOD REST HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 OAK LANE AVE
PHILADELPHIA PA
19126-3340
US

IV. Provider business mailing address

1020 OAK LANE AVE
PHILADELPHIA PA
19126-3340
US

V. Phone/Fax

Practice location:
  • Phone: 215-224-9898
  • Fax: 215-224-9897
Mailing address:
  • Phone: 215-224-9898
  • Fax: 215-224-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number131302
License Number StatePA

VIII. Authorized Official

Name: MR. M. SCOTT CARPENTER
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 215-224-9898