Provider Demographics
NPI:1306841101
Name:ST. AGNES CONTINUING CARE CENTER
Entity Type:Organization
Organization Name:ST. AGNES CONTINUING CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER, VP FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRESKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-339-4223
Mailing Address - Street 1:1900 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2304
Mailing Address - Country:US
Mailing Address - Phone:215-339-4100
Mailing Address - Fax:215-339-0482
Practice Address - Street 1:1900 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2304
Practice Address - Country:US
Practice Address - Phone:215-339-4100
Practice Address - Fax:215-339-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA971002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39-5946Medicare Oscar/Certification