Provider Demographics
NPI:1093840365
Name:SAINT AGNES CONTINUING CARE CENTER
Entity Type:Organization
Organization Name:SAINT AGNES CONTINUING CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V. P. OF FINANCE CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRESKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-339-4223
Mailing Address - Street 1:1900 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2304
Mailing Address - Country:US
Mailing Address - Phone:215-339-4223
Mailing Address - Fax:215-339-0482
Practice Address - Street 1:1500 S COLUMBUS BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-5510
Practice Address - Country:US
Practice Address - Phone:215-339-4747
Practice Address - Fax:215-339-5648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1003050510004Medicaid