Provider Demographics
NPI:1376664839
Name:THE BRYN MAWR TERRACE
Entity Type:Organization
Organization Name:THE BRYN MAWR TERRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-525-8300
Mailing Address - Street 1:773 E HAVERFORD RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3837
Mailing Address - Country:US
Mailing Address - Phone:610-525-8300
Mailing Address - Fax:610-519-0796
Practice Address - Street 1:773 E HAVERFORD RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3837
Practice Address - Country:US
Practice Address - Phone:610-525-8300
Practice Address - Fax:610-519-0796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA023402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005902000OtherBLUE CROSS
PA0116091OtherUS HEALTHCARE
PA0002432000OtherINDEPENDENCE BLUE CROSS
PA0002432000OtherINDEPENDENCE BLUE CROSS