Healthcare Provider Details

I. General information

NPI: 1700266269
Provider Name (Legal Business Name): 2157627000
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2015
Last Update Date: 05/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W GIRARD AVE
PHILADELPHIA PA
19130-1400
US

IV. Provider business mailing address

2100 W GIRARD AVE
PHILADELPHIA PA
19130-1400
US

V. Phone/Fax

Practice location:
  • Phone: 215-865-0800
  • Fax: 215-685-0846
Mailing address:
  • Phone: 215-865-0800
  • Fax: 215-685-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberMD433799
License Number StatePA

VIII. Authorized Official

Name: MISS MARIANNE WARD
Title or Position: DIRECTOR OF OPERATIONS HAHNEMANN PH
Credential:
Phone: 215-762-7000