Provider Demographics
NPI:1164419909
Name:BAPTIST HOME OF PHILADELPHIA
Entity Type:Organization
Organization Name:BAPTIST HOME OF PHILADELPHIA
Other - Org Name:DEER MEADOWS RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOFIA
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, NHA
Authorized Official - Phone:215-624-7575
Mailing Address - Street 1:8301 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2006
Mailing Address - Country:US
Mailing Address - Phone:215-624-7575
Mailing Address - Fax:215-624-7020
Practice Address - Street 1:8301 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2006
Practice Address - Country:US
Practice Address - Phone:215-624-7575
Practice Address - Fax:215-624-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA020202314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0745083Medicaid
395425Medicare ID - Type Unspecified