Provider Demographics
NPI:1134103419
Name:ST JOHN NEUMANN NURSING HOME
Entity Type:Organization
Organization Name:ST JOHN NEUMANN NURSING HOME
Other - Org Name:ST JOHN NEUMANN NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CZENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-368-0900
Mailing Address - Street 1:10400 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3905
Mailing Address - Country:US
Mailing Address - Phone:215-698-5600
Mailing Address - Fax:215-698-5755
Practice Address - Street 1:10400 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3905
Practice Address - Country:US
Practice Address - Phone:215-698-5600
Practice Address - Fax:215-698-5755
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC HEALTH CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-01
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA452202314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007512690001Medicaid
PA0535127OtherAETNA
PA005944OtherIBC KEYSTONE
PA005944OtherIBC KEYSTONE