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NPI Code Detail

MEDICARE: RELIANT PROSPECT PARK, LLC

MEDICARE: RELIANT PROSPECT PARK, 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 Facility162502PA

General Provider Information

NPI Number : 1962837138
Entity Type Code : Organization
Provider Name (Legal Business Name) : RELIANT PROSPECT PARK, LLC
Provider Business Mailing Address
First Line : 3601 ISLAND AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19153-3228
Country : US
Telephone Number : 215-558-3700
Fax Number : 215-558-3701
Provider Business Practice Location Address
First Line : 815 CHESTER PIKE
Second Line :
City : PROSPECT PARK
State : PA
Zip : 19076-2322
Country : US
Telephone Number : 610-586-6262
Fax Number : 610-586-2262
Authorized Official
Title or Position : CFO
Name : ANTHONY J. SCIOLE
Credential :
Telephone Number : 215-558-3700
Provider Enumeration Date : 09/06/2013
Last Update Date : 09/06/2013

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Directions to “RELIANT PROSPECT PARK, LLC ” Practice Location

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