Healthcare Provider Details

I. General information

NPI: 1467449322
Provider Name (Legal Business Name): THE PRESBYTERIAN HOME AT 58TH STREET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 SOUTH 58TH STREET
PHILADELPHIA PA
19143-5910
US

IV. Provider business mailing address

2000 JOSHUA RD
LAFAYETTE HILL PA
19444-2430
US

V. Phone/Fax

Practice location:
  • Phone: 215-724-2218
  • Fax: 215-724-6924
Mailing address:
  • Phone: 610-834-1001
  • Fax: 610-834-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number421902
License Number StatePA

VIII. Authorized Official

Name: MRS. CYNTHIA E HOFFMAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 610-260-1133