Healthcare Provider Details

I. General information

NPI: 1396728366
Provider Name (Legal Business Name): LUTHERAN COMMUNITY AT TELFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 LUTHERAN HOME DR
TELFORD PA
18969-1728
US

IV. Provider business mailing address

12 LUTHERAN HOME DRIVE
TELFORD PA
18969-1787
US

V. Phone/Fax

Practice location:
  • Phone: 215-723-9819
  • Fax: 215-723-3623
Mailing address:
  • Phone: 215-723-9819
  • Fax: 215-723-3623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number144220
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number124502
License Number StatePA

VIII. Authorized Official

Name: MRS. ELLEN NATALIE SHRAGER
Title or Position: NURSING HOME ADMINISTRATOR
Credential: NHA
Phone: 215-723-9819