Provider Demographics
NPI:1386642171
Name:MARY J DREXEL HOME
Entity Type:Organization
Organization Name:MARY J DREXEL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALEK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NHA
Authorized Official - Phone:610-664-5967
Mailing Address - Street 1:238 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2334
Mailing Address - Country:US
Mailing Address - Phone:610-664-5967
Mailing Address - Fax:610-664-6687
Practice Address - Street 1:238 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2334
Practice Address - Country:US
Practice Address - Phone:610-664-5967
Practice Address - Fax:610-664-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA131402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006109000OtherPERSONAL CHOICE
PA0006109000OtherKEYSTONE
PA00746385-01OtherAMERICHOICE
PA0944483OtherAETNA
PA0007463850001Medicaid
PA0006109000OtherINDEPENDENCE BLUE CROSS
PA21577OtherSENIOR PARTNERS
PA21577OtherHEALTH PARTNERS
PA396023Medicare ID - Type Unspecified