Provider Demographics
NPI:1578561049
Name:PHOEBE BERKS HEALTH CARE CENTER INC
Entity Type:Organization
Organization Name:PHOEBE BERKS HEALTH CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
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:610-794-5142
Mailing Address - Street 1:1 READING DRIVE
Mailing Address - Street 2:
Mailing Address - City:WERNESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565
Mailing Address - Country:US
Mailing Address - Phone:610-927-8574
Mailing Address - Fax:610-927-8422
Practice Address - Street 1:1 HEIDELBERG DR
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565
Practice Address - Country:US
Practice Address - Phone:610-927-8574
Practice Address - Fax:610-927-8422
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOEBE BERKS HEALTH CARE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-08
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA324414261QM0850X
PA167802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013042160001Medicaid
PA2079OtherHIGHMARK BLUE SHIELD
PA324414OtherDEPT OF AGING
PA395880OtherCAPITAL BLUE CROSS
PA2079OtherHIGHMARK BLUE SHIELD