MEDICARE: GREEN ACRES REHABILITATION & NURSING CENTER

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	591902	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13111	OTHER		AETNA US HEALTHCARE
2	25206	OTHER		GREEN ACRES
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1027618	OTHER		KEYSTONE MERCY HEALTHPLAN
5	0005891000	OTHER		KEYSTONE 65
6	PA235	OTHER	PA	ELDERHEALTH
7	0005891000	OTHER		BLUE CROSS
8	0095121401	OTHER		AMERICHOICE

General Provider Information

NPI Number	:	1720041874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN ACRES REHABILITATION & NURSING CENTER

Provider Business Mailing Address
First Line	:	4 IVYBROOK BLVD
Second Line	:
City	:	IVYLAND
State	:	PA
Zip	:	18974-1700
Country	:	US
Telephone Number	:	215-357-6055
Fax Number	:	215-357-6968

Provider Business Practice Location Address
First Line	:	1401 IVY HILL RD
Second Line	:
City	:	WYNDMOOR
State	:	PA
Zip	:	19150-1516
Country	:	US
Telephone Number	:	215-357-6055
Fax Number	:	215-357-6968

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALLEN SEGAL
Credential	:
Telephone Number	:	215-357-6055

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/21/2022

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Directions to “GREEN ACRES REHABILITATION & NURSING CENTER ” Practice Location

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