Provider Demographics
NPI:1225036544
Name:MARWOOD REST HOME, INC.
Entity Type:Organization
Organization Name:MARWOOD REST HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:M.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:215-224-9898
Mailing Address - Street 1:1020 OAK LANE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-3340
Mailing Address - Country:US
Mailing Address - Phone:215-224-9898
Mailing Address - Fax:215-224-9897
Practice Address - Street 1:1020 OAK LANE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-3340
Practice Address - Country:US
Practice Address - Phone:215-224-9898
Practice Address - Fax:215-224-9897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA131302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007548970001Medicaid
PA395535Medicare ID - Type UnspecifiedMEDICARE