Provider Demographics
NPI:1366443970
Name:PAUL'S RUN
Entity Type:Organization
Organization Name:PAUL'S RUN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARNUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-643-6333
Mailing Address - Street 1:250 N BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3524
Mailing Address - Country:US
Mailing Address - Phone:215-643-6333
Mailing Address - Fax:215-643-6791
Practice Address - Street 1:9896 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-5202
Practice Address - Country:US
Practice Address - Phone:215-934-3000
Practice Address - Fax:215-934-3018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA176990310400000X
PA161902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
0908820001OtherDMERC SUPPLIER #
PA0012939630002Medicaid
0908820001OtherDMERC SUPPLIER #