Provider Demographics
NPI:1477665198
Name:WYNCOTE CHURCH HOME
Entity Type:Organization
Organization Name:WYNCOTE CHURCH HOME
Other - Org Name:PHOEBE WYNCOTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-794-5131
Mailing Address - Street 1:208 FERNBROOK AVENUE
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-1532
Mailing Address - Country:US
Mailing Address - Phone:215-883-2620
Mailing Address - Fax:215-690-3340
Practice Address - Street 1:208 FERNBROOK AVENUE
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-1509
Practice Address - Country:US
Practice Address - Phone:215-883-2620
Practice Address - Fax:215-885-9245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA232102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007565230002Medicaid
39A427Medicare Oscar/Certification