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General NPI Number Information
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NPI Number | 1164419909
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Entity Type | Organization
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Legal Business Name | BAPTIST HOME OF PHILADELPHIA
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 12/05/2008
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Provider Practice Location Address
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Address Line | 8301 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2006
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Country | US
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Telephone | 215-624-7575
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Fax | 215-624-7020
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Provider Business Mailing Address
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Address Line | 8301 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2006
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Country | US
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Telephone | 215-624-7575
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Fax | 215-624-7020
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Authorized Official
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Title or Position | COO / ADMINISTRATOR
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Name | LISA M SOFIA
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Credential | BSN, NHA
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Telephone | 215-624-7575
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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 | 020202
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License Number State | PA
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