=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235259128
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARRINGTON PLACE OF CHESTNUT HILL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 551 E EVERGREEN AVE
-----------------------------------------------------
City | WYNDMOOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19038-8321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-233-6300
-----------------------------------------------------
Fax | 215-233-6384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1022 MAIN ST SUITE H
-----------------------------------------------------
City | DUNEDIN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34698-5238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-723-3000
-----------------------------------------------------
Fax | 727-723-3075
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. BEN ATKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-723-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------