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NPI Code Detail

MEDICARE: CHURCH LANE SENIOR SERVICES, LLC

MEDICARE: CHURCH LANE SENIOR SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility023102PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194728493
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHURCH LANE SENIOR SERVICES, LLC
Provider Business Mailing Address
First Line : 956 E RAILROAD AVE
Second Line :
City : BRYN MAWR
State : PA
Zip : 19010-3831
Country : US
Telephone Number : 610-525-8412
Fax Number : 610-525-1371
Provider Business Practice Location Address
First Line : 43 CHURCH LN
Second Line :
City : BROOMALL
State : PA
Zip : 19008-2503
Country : US
Telephone Number : 610-356-3003
Fax Number : 610-353-5859
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MR. MICHAEL J. CALLAN
Credential :
Telephone Number : 610-527-4277
Provider Enumeration Date : 05/31/2005
Last Update Date : 08/22/2020

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Directions to “CHURCH LANE SENIOR SERVICES, LLC ” Practice Location

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