MEDICARE: BAKERS BAY NURSING ASSOCIATES

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	183502	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0005611000	OTHER	PA	IBC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649265414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAKERS BAY NURSING ASSOCIATES

Provider Business Mailing Address
First Line	:	9501 STATE RD
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19114-3020
Country	:	US
Telephone Number	:	215-632-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	9501 STATE RD
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19114-3020
Country	:	US
Telephone Number	:	215-632-5700
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MRS. ANDREA M NATICCHIONE
Credential	:
Telephone Number	:	610-832-8000

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	09/20/2012

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