Provider Demographics
NPI:1396850368
Name:MAIN LINE HOSPITALS, INC.
Entity Type:Organization
Organization Name:MAIN LINE HOSPITALS, INC.
Other - Org Name:BRYN MAWR REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUONGIORNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-337-8480
Mailing Address - Street 1:3803 W CHESTER PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2336
Mailing Address - Country:US
Mailing Address - Phone:484-337-1816
Mailing Address - Fax:
Practice Address - Street 1:414 PAOLI PIKE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3311
Practice Address - Country:US
Practice Address - Phone:484-596-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA540201283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001063000OtherKEYSTONE 65
NJ4205707Medicaid
P00838OtherCHAMPUS TRICARE NORTH REG
PA0001063000OtherINDEPENDENCE BLUE CROSS
0078104301OtherAMERICHOICE HMA
08382OtherHEALTH PARTNERS
DE000066905Medicaid
PA0524895OtherCIGNA
0001121OtherAETNA
NY01136121Medicaid
PA1007354280038Medicaid
PA100770006Medicaid
258209OtherMAMSI/ALLIANCE PPO
MD17000060Medicaid
0001063000OtherAMERIHEALTH
00557261-01OtherAMERICHOICE-MEDICARE
60088OtherKEYSTONE MERCY
PA100770006Medicaid