Healthcare Provider Details

I. General information

NPI: 1497047310
Provider Name (Legal Business Name): CLIVEDEN NURSING AND REHABILITATION CENTER PA, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 GREENE ST
PHILADELPHIA PA
19119-3231
US

IV. Provider business mailing address

1922 GREENSPRING DR SUITE 3
TIMONIUM MD
21093-7603
US

V. Phone/Fax

Practice location:
  • Phone: 410-923-2415
  • Fax: 410-923-2416
Mailing address:
  • Phone: 410-923-2415
  • Fax: 410-923-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number330402
License Number StatePA

VIII. Authorized Official

Name: BARBARA MCADAMS
Title or Position: DIRECTOR OF ACCOUNTS RECEIVABLE
Credential:
Phone: 410-923-2415