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NPI Code Detail

MEDICARE: ST. AGNES LONG TERM INTENSIVE CARE, LLP

MEDICARE: ST. AGNES LONG TERM INTENSIVE CARE, LLP
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
1282E00000XLong Term Care Hospital97100101PA

General Provider Information

NPI Number : 1609871318
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. AGNES LONG TERM INTENSIVE CARE, LLP
Provider Business Mailing Address
First Line : 1900 S BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19145-2304
Country : US
Telephone Number : 215-339-4100
Fax Number : 215-339-0482
Provider Business Practice Location Address
First Line : 1900 S BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19145-2304
Country : US
Telephone Number : 215-339-4100
Fax Number : 215-339-0482
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER, VP FINANCE
Name : MRS. TERESA A. GRESKO
Credential :
Telephone Number : 215-339-4223
Provider Enumeration Date : 06/17/2005
Last Update Date : 08/22/2020

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