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NPI Code Detail

MEDICARE: 1245 CHURCH ROAD OPERATIONS LLC

MEDICARE: 1245 CHURCH ROAD OPERATIONS 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
1314000000XSkilled Nursing Facility034402PA

Other Identifiers

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

General Provider Information

NPI Number : 1639351943
Entity Type Code : Organization
Provider Name (Legal Business Name) : 1245 CHURCH ROAD OPERATIONS LLC
Provider Business Mailing Address
First Line : 101 E STATE ST
Second Line :
City : KENNETT SQUARE
State : PA
Zip : 19348-3109
Country : US
Telephone Number : 610-925-4436
Fax Number : 610-925-4351
Provider Business Practice Location Address
First Line : 1245 CHURCH RD
Second Line :
City : WYNCOTE
State : PA
Zip : 19095-1800
Country : US
Telephone Number : 215-884-9990
Fax Number : 215-884-5579
Authorized Official
Title or Position : SECRETARY
Name : MICHAEL T BERG
Credential :
Telephone Number : 610-444-6350
Provider Enumeration Date : 11/28/2007
Last Update Date : 06/26/2025

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