MEDICARE: IVY HILL SNF 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
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1558549170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVY HILL SNF LLC

Provider Business Mailing Address
First Line	:	4597 ROUTE 9 N
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-3382
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 IVY HILL RD
Second Line	:
City	:	WYNDMOOR
State	:	PA
Zip	:	19150-1516
Country	:	US
Telephone Number	:	215-233-5605
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED MEMBER
Name	:	NATHAN STERN
Credential	:
Telephone Number	:	732-942-1644

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	04/09/2008

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