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General NPI Number Information
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NPI Number | 1225188386
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Entity Type | Organization
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Legal Business Name | BAKERS BAY ELDERLY ASSOCIATES
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 9503 STATE RD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-3039
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Country | US
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Telephone | 215-824-4200
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Fax | 215-824-2683
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Provider Business Mailing Address
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Address Line | 9503 STATE RD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-3039
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Country | US
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Telephone | 215-824-4200
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Fax | 215-824-2683
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SUSAN HOFFMAN
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Credential | ADMINISTRATOR
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Telephone | 215-824-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 179150
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License Number State | PA
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