=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972913036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SKYLINE CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2014
-----------------------------------------------------
Last Update Date | 04/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8601 STENTON AVE
-----------------------------------------------------
City | WYNDMOOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19038-8312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-233-6231
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8601 STENTON AVE
-----------------------------------------------------
City | WYNDMOOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19038-8312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | DEBORAH MAHNKEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-233-6231
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 05290501
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------