=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396728366
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUTHERAN COMMUNITY AT TELFORD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2005
-----------------------------------------------------
Last Update Date | 12/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 LUTHERAN HOME DR
-----------------------------------------------------
City | TELFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18969-1728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-723-9819
-----------------------------------------------------
Fax | 215-723-3623
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 LUTHERAN HOME DRIVE
-----------------------------------------------------
City | TELFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18969-1787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-723-9819
-----------------------------------------------------
Fax | 215-723-3623
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSING HOME ADMINISTRATOR
-----------------------------------------------------
Name | MRS. ELLEN NATALIE SHRAGER
-----------------------------------------------------
Credential | NHA
-----------------------------------------------------
Telephone | 215-723-9819
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 144220
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 124502
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------