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NPI Code Detail

MEDICARE: 899 CECIL AVENUE OPERATIONS LLC

MEDICARE: 899 CECIL AVENUE 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 Facility02-010MD

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 : 1770765240
Entity Type Code : Organization
Provider Name (Legal Business Name) : 899 CECIL AVENUE 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 : 1221 WAUGH CHAPEL RD
Second Line :
City : GAMBRILLS
State : MD
Zip : 21054-1608
Country : US
Telephone Number : 410-923-2020
Fax Number : 410-987-1600
Authorized Official
Title or Position : ASSISTANT SECRETARY
Name : MICHAEL T. BERG
Credential :
Telephone Number : 505-468-4752
Provider Enumeration Date : 11/27/2007
Last Update Date : 01/15/2016

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