Healthcare Provider Details

I. General information

NPI: 1396148706
Provider Name (Legal Business Name): DEER MEADOWS OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELIYAHU MIRLIS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 973-796-6175