Provider Demographics
NPI:1538142013
Name:GOLDEN SLIPPER HEALTH AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:GOLDEN SLIPPER HEALTH AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALO
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:215-722-2300
Mailing Address - Street 1:7800 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3812
Mailing Address - Country:US
Mailing Address - Phone:215-722-2300
Mailing Address - Fax:215-722-1419
Practice Address - Street 1:7800 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3812
Practice Address - Country:US
Practice Address - Phone:215-722-2300
Practice Address - Fax:215-722-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA210102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007767990003Medicaid
PA0006205000OtherINDEPENDENCE BLUE CROSS
PA1007767990003Medicaid