Healthcare Provider Details

I. General information

NPI: 1487776720
Provider Name (Legal Business Name): SILVER STREAM CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 PENNLYN PIKE
SPRING HOUSE PA
19477
US

IV. Provider business mailing address

829 MEADOWBROOK DR
HUNTINGDON VALLEY PA
19006-6931
US

V. Phone/Fax

Practice location:
  • Phone: 215-646-1500
  • Fax:
Mailing address:
  • Phone: 215-646-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOC006464L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. ANITA WAGNER
Title or Position: AREA DIR
Credential: PT
Phone: 215-441-1335