Basic Information
| Provider Information | |||||||||
| NPI: | 1487713384 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID COUNTY SENIOR SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 MEDIA LINE RD | ||||||||
| Address2: | |||||||||
| City: | NEWTOWN SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190734601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103536642 | ||||||||
| FaxNumber: | 6103537950 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 GARRETT RD | ||||||||
| Address2: | BARCLAY SQUARE ADULT DAY SERVICES | ||||||||
| City: | UPPER DARBY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190824519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106260662 | ||||||||
| FaxNumber: | 6106260668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SULIMAY | ||||||||
| AuthorizedOfficialFirstName: | LESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6103536642 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | 301430 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
ID Information
| ID | Type | State | Issuer | Description | 1000058970002 | 05 | PA | MEDICAID | 1000058970006 | 05 | PA | MEDICAID |