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General NPI Number Information
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NPI Number | 1427230739
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Entity Type | Organization
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Legal Business Name | 1526 LOMBARD STREET OPERATIONS LLC
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 1526 LOMBARD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-1625
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Country | US
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Telephone | 215-546-6960
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Fax | 215-732-7451
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Provider Business Mailing Address
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Address Line | 101 E STATE ST
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City | KENNETT SQUARE
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State | PA
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Zip | 19348-3109
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Country | US
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Telephone | 610-925-2009
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Fax | 610-347-4098
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | MICHAEL T BERG
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Credential |
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Telephone | 505-468-4742
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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 | 200402
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License Number State | PA
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