Basic Information
| Provider Information | |||||||||
| NPI: | 1417557174 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KENSINGTON HOSPITAL NON HOSPITAL SHORT TERM/LONG TERM REHAB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 W. DIAMOND ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191221721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154268100 | ||||||||
| FaxNumber: | 2159652344 | ||||||||
| Practice Location | |||||||||
| Address1: | 136 W. DIAMOND ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191221721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154268100 | ||||||||
| FaxNumber: | 2159652344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2020 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | ZUKOWSKI | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 2154268100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KENSINGTON HOSPITAL | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.