Provider Demographics
NPI:1598749558
Name:AHF- MONTGOMERY INC
Entity Type:Organization
Organization Name:AHF- MONTGOMERY INC
Other - Org Name:CHELTENHAM NURSING & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAEMMERLE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, INACTIVE
Authorized Official - Phone:614-760-7352
Mailing Address - Street 1:5920 VENTURE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2236
Mailing Address - Country:US
Mailing Address - Phone:614-760-7352
Mailing Address - Fax:614-760-7356
Practice Address - Street 1:600 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-3045
Practice Address - Country:US
Practice Address - Phone:215-927-7300
Practice Address - Fax:215-224-0850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN HEALTH FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-02
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032202314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012177100001Medicaid
PA0012177100001Medicaid