MEDICARE: BANCROFT NEUROHEALTH

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	135180	PA

General Provider Information

NPI Number	:	1720105570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BANCROFT NEUROHEALTH

Provider Business Mailing Address
First Line	:	304 OLD LANCASTER RD
Second Line	:
City	:	MERION STATION
State	:	PA
Zip	:	19066-1526
Country	:	US
Telephone Number	:	610-727-0290
Fax Number	:	610-747-0294

Provider Business Practice Location Address
First Line	:	3901 CONSHOHOCKEN AVE
Second Line	:	GREENBRIAR - #4311
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-5430
Country	:	US
Telephone Number	:	215-877-2373
Fax Number	:	610-747-0294

Authorized Official
Title or Position	:	SENIOR DIRECTOR
Name	:	SHARON E WILLIAMS-TAYLOR
Credential	:	M.S. STLDR
Telephone Number	:	610-747-0290

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	03/14/2012

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