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NPI Code Detail

MEDICARE: ST JOHN NEUMANN NURSING HOME

MEDICARE: ST JOHN NEUMANN NURSING HOME
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
1332BP3500XParenteral & Enteral Nutrition Supplies (DME)452202PA

General Provider Information

NPI Number : 1205903630
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST JOHN NEUMANN NURSING HOME
Provider Business Mailing Address
First Line : 10400 ROOSEVELT BLVD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19116-3905
Country : US
Telephone Number : 215-698-5600
Fax Number : 215-368-5254
Provider Business Practice Location Address
First Line : 10400 ROOSEVELT BLVD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19116-3905
Country : US
Telephone Number : 215-698-5600
Fax Number : 215-368-5254
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MR. MICHAEL CZEKNER
Credential :
Telephone Number : 215-368-0900
Provider Enumeration Date : 11/29/2006
Last Update Date : 09/23/2008

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Directions to “ST JOHN NEUMANN NURSING HOME ” Practice Location

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