=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063407096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST GROVE HOSPITAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2005
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 BELL TOWER LN
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19363-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-998-1700
-----------------------------------------------------
Fax | 610-998-1799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 BELL TOWER LN
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19363-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-998-1700
-----------------------------------------------------
Fax | 610-998-1799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING COORDINATOR
-----------------------------------------------------
Name | MS. MICHELLE BUONOMO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-998-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 740005
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------