Provider Demographics
NPI:1447206453
Name:HOLLAND GLEN
Entity Type:Organization
Organization Name:HOLLAND GLEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-766-1500
Mailing Address - Street 1:6151 KELLERS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947-1021
Mailing Address - Country:US
Mailing Address - Phone:215-766-1500
Mailing Address - Fax:215-766-1506
Practice Address - Street 1:412 S YORK RD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-3949
Practice Address - Country:US
Practice Address - Phone:215-441-1178
Practice Address - Fax:215-441-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA117470314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000026520005Medicaid