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General NPI Number Information
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NPI Number | 1902895550
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Entity Type | Organization
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Legal Business Name | JENNER'S POND INC.
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 2000 GREENBRIAR LN
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City | WEST GROVE
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State | PA
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Zip | 19390-9485
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Country | US
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Telephone | 610-869-6770
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 GREENBRIAR LN
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City | WEST GROVE
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State | PA
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Zip | 19390-9485
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Country | US
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Telephone | 610-869-6770
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | TONI MCCLAY
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Credential |
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Telephone | 610-869-6802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 15700201
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 101500
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License Number State | PA
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