MEDICARE: THE 58TH STREET PRESBYTERIAN HOMES

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	316170	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1588708655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE 58TH STREET PRESBYTERIAN HOMES

Provider Business Mailing Address
First Line	:	2050 S 58TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-5932
Country	:	US
Telephone Number	:	215-724-2218
Fax Number	:	215-724-6924

Provider Business Practice Location Address
First Line	:	2050 S 58TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-5932
Country	:	US
Telephone Number	:	215-724-2218
Fax Number	:	215-724-6924

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SHARON WHITAKER
Credential	:
Telephone Number	:	215-724-2218

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	08/22/2020

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