Provider Demographics
NPI:1477830305
Name:MORAVIA HEALTH NETWORK, LLC
Entity Type:Organization
Organization Name:MORAVIA HEALTH NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:C. FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:IGWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-717-8650
Mailing Address - Street 1:1500 WALNUT ST STE 1900
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3509
Mailing Address - Country:US
Mailing Address - Phone:215-717-8650
Mailing Address - Fax:215-717-7839
Practice Address - Street 1:1500 WALNUT ST STE 1900
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:215-717-8650
Practice Address - Fax:215-717-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-06
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA32093601251E00000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028762650001Medicaid