Provider Demographics
NPI:1134113293
Name:RHA/PENNSYLVANIA NURSING HOME INC
Entity Type:Organization
Organization Name:RHA/PENNSYLVANIA NURSING HOME INC
Other - Org Name:PROSPECT PARK HEALTH & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-586-6262
Mailing Address - Street 1:815 CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19076-2322
Mailing Address - Country:US
Mailing Address - Phone:610-586-6262
Mailing Address - Fax:610-586-4420
Practice Address - Street 1:815 CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:PA
Practice Address - Zip Code:19076-2322
Practice Address - Country:US
Practice Address - Phone:610-586-6262
Practice Address - Fax:610-586-4420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA162502314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005798000OtherBLUE CROSS
PA100728085-0006Medicaid
PA100728085-0006Medicaid
0005798000OtherBLUE CROSS