Provider Demographics
NPI:1275660656
Name:MAIN LINE HOSPITALS, INC.
Entity Type:Organization
Organization Name:MAIN LINE HOSPITALS, INC.
Other - Org Name:AMERICAN DAY TREATMENT CENTER - DREXEL HILL
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUONGIORNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-526-8480
Mailing Address - Street 1:950 E HAVERFORD RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3850
Mailing Address - Country:US
Mailing Address - Phone:610-526-8480
Mailing Address - Fax:
Practice Address - Street 1:401 PILGRIM LN
Practice Address - Street 2:SUITE 100
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-5000
Practice Address - Country:US
Practice Address - Phone:610-645-7520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA110260261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
390139OtherADTC AMERIHEALTH
0001443OtherADTC AETNA NON HMO
PA1007354280017Medicaid
0001101000OtherIBC - ADTC
0001101000OtherIBC - ADTC