Provider Demographics
NPI:1265847008
Name:COMMUNITY CARE CENTER OF THE NORTHEAST
Entity Type:Organization
Organization Name:COMMUNITY CARE CENTER OF THE NORTHEAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:H
Authorized Official - Last Name:STEINKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-335-4416
Mailing Address - Street 1:2417 WELSH RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2213
Mailing Address - Country:US
Mailing Address - Phone:215-335-4416
Mailing Address - Fax:215-338-4426
Practice Address - Street 1:2417 WELSH RD
Practice Address - Street 2:SUITE 202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2213
Practice Address - Country:US
Practice Address - Phone:215-335-4416
Practice Address - Fax:215-338-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA12463601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care