Basic Information
| Provider Information | |||||||||
| NPI: | 1790005700 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SENIOR CARE CENTERS OF PENNSYLVANIA, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SENIOR CARE OF BROOMALL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 NESHAMINY INTERPLEX | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | TREVOSE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190536964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156426600 | ||||||||
| FaxNumber: | 2156426610 | ||||||||
| Practice Location | |||||||||
| Address1: | 1991 SPROUL RD | ||||||||
| Address2: | SUITE 850 | ||||||||
| City: | BROOMALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190083512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103251600 | ||||||||
| FaxNumber: | 6103251495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2010 | ||||||||
| LastUpdateDate: | 01/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | HOCKENBURY | ||||||||
| AuthorizedOfficialFirstName: | DEBORA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CONTRACTS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2156426600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 385H00000X | 304680 | PA | N | Respite Care Facility | Respite Care | 261QA0600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
ID Information
| ID | Type | State | Issuer | Description | APPLIED FOR | 05 | PA | MEDICAID |