Healthcare Provider Details

I. General information

NPI: 1538142013
Provider Name (Legal Business Name): GOLDEN SLIPPER HEALTH AND REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 BUSTLETON AVE
PHILADELPHIA PA
19152-3812
US

IV. Provider business mailing address

7800 BUSTLETON AVE
PHILADELPHIA PA
19152-3812
US

V. Phone/Fax

Practice location:
  • Phone: 215-722-2300
  • Fax: 215-722-1419
Mailing address:
  • Phone: 215-722-2300
  • Fax: 215-722-1419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number210102
License Number StatePA

VIII. Authorized Official

Name: MS. ANNETTE PALO
Title or Position: EXECUTIVE DIRECTOR
Credential: NHA
Phone: 215-722-2300