Provider Demographics
NPI:1467449322
Name:THE PRESBYTERIAN HOME AT 58TH STREET
Entity Type:Organization
Organization Name:THE PRESBYTERIAN HOME AT 58TH STREET
Other - Org Name:58TH STREET PRESBYTERIAN HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-260-1133
Mailing Address - Street 1:2000 JOSHUA RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2430
Mailing Address - Country:US
Mailing Address - Phone:610-834-1001
Mailing Address - Fax:610-834-6556
Practice Address - Street 1:2050 SOUTH 58TH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-5910
Practice Address - Country:US
Practice Address - Phone:215-724-2218
Practice Address - Fax:215-724-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA421902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100777885Medicaid
PA395501Medicare UPIN
PA100777885Medicaid