Provider Demographics
NPI:1487644225
Name:HOLY REDEEMER HEALTH SYSTEM
Entity Type:Organization
Organization Name:HOLY REDEEMER HEALTH SYSTEM
Other - Org Name:LAFAYETTE REDEEMER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-856-1123
Mailing Address - Street 1:8580 VERREE RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-1370
Mailing Address - Country:US
Mailing Address - Phone:215-214-2800
Mailing Address - Fax:215-745-6713
Practice Address - Street 1:8580 VERREE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-1370
Practice Address - Country:US
Practice Address - Phone:215-214-2800
Practice Address - Fax:215-745-6713
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY REDEEMER HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-24
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA125602314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001264530002Medicaid
PA395704Medicare Oscar/Certification