MEDICARE: KEARSLEY LONG TERM CARE

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	032502	PA

General Provider Information

NPI Number	:	1841308061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEARSLEY LONG TERM CARE

Provider Business Mailing Address
First Line	:	2100 N 49TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2633
Country	:	US
Telephone Number	:	215-877-1565
Fax Number	:	215-877-0738

Provider Business Practice Location Address
First Line	:	2100 N 49TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2633
Country	:	US
Telephone Number	:	215-877-1565
Fax Number	:	215-877-0738

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE
Name	:	MR. DONALD LEVESQUE
Credential	:
Telephone Number	:	215-951-4596

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	08/20/2008

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Directions to “KEARSLEY LONG TERM CARE ” Practice Location

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