Provider Demographics
NPI:1578672796
Name:PA DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
Entity Type:Organization
Organization Name:PA DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
Other - Org Name:DELAWARE VALLEY VETERANS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL SERVICES ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:814-242-7789
Mailing Address - Street 1:2701 SOUTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1205
Mailing Address - Country:US
Mailing Address - Phone:215-965-5900
Mailing Address - Fax:215-965-0377
Practice Address - Street 1:2701 SOUTHAMPTON RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1205
Practice Address - Country:US
Practice Address - Phone:215-965-5900
Practice Address - Fax:215-965-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA127202002865M2000X, 313M00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068582Medicare PIN
PA1244320002Medicare NSC