=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770815672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VNA OF GREATER PHILADELPHIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2010
-----------------------------------------------------
Last Update Date | 02/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 HENRY AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19129-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-581-2057
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3300 HENRY AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19129-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-581-2057
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. DEBORAH WAY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 215-581-2057
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | SP010634
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------