Healthcare Provider Details

I. General information

NPI: 1396222816
Provider Name (Legal Business Name): RUDINA A MAHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 MERIDIAN WAY
YARDLEY PA
19067-5835
US

IV. Provider business mailing address

1005 MERIDIAN WAY
YARDLEY PA
19067-5835
US

V. Phone/Fax

Practice location:
  • Phone: 215-870-6795
  • Fax: 855-275-8434
Mailing address:
  • Phone: 215-870-6795
  • Fax: 855-275-8434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier253Z00000X
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: