Provider Demographics
NPI:1073646410
Name:ST EDMOND'S HOME FOR CHILDREN
Entity Type:Organization
Organization Name:ST EDMOND'S HOME FOR CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLOFINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-525-8800
Mailing Address - Street 1:320 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1238
Mailing Address - Country:US
Mailing Address - Phone:610-525-8800
Mailing Address - Fax:610-525-2693
Practice Address - Street 1:320 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1238
Practice Address - Country:US
Practice Address - Phone:610-525-8800
Practice Address - Fax:610-525-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000023670005Medicaid