Provider Demographics
NPI:1568667137
Name:ANGELA JANE PAVILION ACUTE REHABILITATION HOSPITAL
Entity Type:Organization
Organization Name:ANGELA JANE PAVILION ACUTE REHABILITATION HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE MARIE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:215-708-1200
Mailing Address - Street 1:8410 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2012
Mailing Address - Country:US
Mailing Address - Phone:215-708-1200
Mailing Address - Fax:215-708-2967
Practice Address - Street 1:8410 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2012
Practice Address - Country:US
Practice Address - Phone:215-708-1200
Practice Address - Fax:215-708-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA12800101283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA393051Medicare ID - Type UnspecifiedACUTE REHAB. HOSPITAL