Provider Demographics
NPI:1043430457
Name:SENIOR CARE CENTERS OF PENNSYLVANIA, INC.
Entity Type:Organization
Organization Name:SENIOR CARE CENTERS OF PENNSYLVANIA, INC.
Other - Org Name:SENIOR CARE OF BLUE BELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:O
Authorized Official - Last Name:MEHNERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-642-6600
Mailing Address - Street 1:7 NESHAMINY INTERPLEX DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053
Mailing Address - Country:US
Mailing Address - Phone:215-642-6600
Mailing Address - Fax:215-642-6610
Practice Address - Street 1:475 NORRISTOWN RD
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2356
Practice Address - Country:US
Practice Address - Phone:610-828-4144
Practice Address - Fax:610-828-3889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA281300385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007616510010Medicaid