Healthcare Provider Details

I. General information

NPI: 1306979612
Provider Name (Legal Business Name): CARDINAL KROL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 S SPROUL RD
SPRINGFIELD PA
19064-1137
US

IV. Provider business mailing address

20 E CLEVELAND AVE
NORWOOD PA
19074-1207
US

V. Phone/Fax

Practice location:
  • Phone: 610-543-3380
  • Fax: 610-543-5397
Mailing address:
  • Phone: 610-543-3380
  • Fax: 610-543-5397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StatePA

VIII. Authorized Official

Name: MS. PATTI MENSZAK
Title or Position: ADMINISTRATOR
Credential:
Phone: 610-543-3380