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General NPI Number Information
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NPI Number | 1477537827
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Entity Type | Organization
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Legal Business Name | PHILADELPHIA PROTESTANT HOME
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 6500 TABOR RD
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City | PHILADELPHIA
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State | PA
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Zip | 19111-5332
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Country | US
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Telephone | 215-697-8000
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Fax | 215-697-8018
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Provider Business Mailing Address
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Address Line | 6500 TABOR RD
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City | PHILADELPHIA
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State | PA
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Zip | 19111-5332
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Country | US
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Telephone | 215-697-8000
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Fax | 215-697-8018
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Authorized Official
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Title or Position | CFO
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Name | MR. DAVID WICKER
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Credential |
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Telephone | 215-697-8357
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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 | 144500
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 681002
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License Number State | PA
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