Provider Demographics
NPI:1003052820
Name:LIFE ST. MARY
Entity Type:Organization
Organization Name:LIFE ST. MARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:215-710-6114
Mailing Address - Street 1:1201 LANGHORNE-NEWTOWN RD.
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1201
Mailing Address - Country:US
Mailing Address - Phone:215-710-6114
Mailing Address - Fax:215-710-2298
Practice Address - Street 1:2500 INTERPLEX DRIVE
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6943
Practice Address - Country:US
Practice Address - Phone:215-710-6114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
H6551OtherCMS