Provider Demographics
NPI:1356457782
Name:CHATHAM ACRES NURSING CENTER, INC.
Entity Type:Organization
Organization Name:CHATHAM ACRES NURSING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOUNTFORD
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:610-869-2456
Mailing Address - Street 1:315 EAST LONDON GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19318
Mailing Address - Country:US
Mailing Address - Phone:610-869-2456
Mailing Address - Fax:610-869-9860
Practice Address - Street 1:315 EAST LONDON GROVE ROAD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:PA
Practice Address - Zip Code:19318
Practice Address - Country:US
Practice Address - Phone:610-869-2456
Practice Address - Fax:610-869-9860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032102313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015756410001Medicaid