Healthcare Provider Details
I. General information
NPI: 1346286200
Provider Name (Legal Business Name): MID COUNTY SENIOR SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/21/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
30 WEST AVE
WAYNE PA
19087-3322
US
IV. Provider business mailing address
101 E STATE ST
KENNETT SQUARE PA
19348-3109
US
V. Phone/Fax
- Phone: 610-688-3635
- Fax: 610-688-4650
- Phone: 610-925-4436
- Fax: 610-925-4351
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 314000000X |
| Taxonomy | Skilled Nursing Facility |
| License Number | 750102 |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 1000058970004 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 2 | |
| Identifier | 30001322 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | KEYSTONE MERCY |
| # 3 | |
| Identifier | 2865706 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA-HMO |
| # 4 | |
| Identifier | IY1102 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTH NET OF PA |
| # 5 | |
| Identifier | 127 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | ELDER HEALTH |
| # 6 | |
| Identifier | 0005773000 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | IBC |
| # 7 | |
| Identifier | 25375 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTH PARTNERS |
| # 8 | |
| Identifier | 260258 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTH AMERICA |
| # 9 | |
| Identifier | 0005773000 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AMERIHEALTH |
| # 10 | |
| Identifier | 317138 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | US FAMILY HEALTH PLAN |
| # 11 | |
| Identifier | 001226 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HORIZON - SUB |
| # 12 | |
| Identifier | 395332 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HORIZION - SNF |
VIII. Authorized Official
Name:
JANE
DROPESKEY
Title or Position: CORPORATE MANAGER
Credential:
Phone: 610-925-4231
