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General NPI Number Information
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NPI Number | 1043207152
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Entity Type | Organization
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Legal Business Name | EVANGELICAL MANOR
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8401 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2034
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Country | US
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Telephone | 215-624-5800
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Fax | 215-335-1477
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Provider Business Mailing Address
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Address Line | 928 JAYMOR RD SUITE B-150
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City | SOUTHAMPTON
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State | PA
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Zip | 18966-3826
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Country | US
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Telephone | 215-354-9586
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Fax | 215-354-1435
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SUZANNE LACHMAN
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Credential | NHA
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Telephone | 215-624-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 311202
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License Number State | PA
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