MEDICARE: COURTLAND II, INC.

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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1265567648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURTLAND II, INC.

Provider Business Mailing Address
First Line	:	6970 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2114
Country	:	US
Telephone Number	:	215-951-7700
Fax Number	:	215-951-7709

Provider Business Practice Location Address
First Line	:	6970 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2114
Country	:	US
Telephone Number	:	215-951-7611
Fax Number	:	215-951-7709

Authorized Official
Title or Position	:	CLINICAL COORDINATOR
Name	:	MR. JAMES REILLY
Credential	:	RN, MSN, MBA
Telephone Number	:	215-951-7611

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	01/02/2008

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