Provider Demographics
NPI:1619951993
Name:ST FRANCIS COUNTRY HOUSE
Entity Type:Organization
Organization Name:ST FRANCIS COUNTRY HOUSE
Other - Org Name:ST FRANCIS COUNTRY HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CZEKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-368-0900
Mailing Address - Street 1:1412 LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1218
Mailing Address - Country:US
Mailing Address - Phone:610-461-6510
Mailing Address - Fax:610-461-3558
Practice Address - Street 1:1412 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1218
Practice Address - Country:US
Practice Address - Phone:610-461-6510
Practice Address - Fax:610-461-3558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC HEALTH CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-01
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA190502314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5872OtherIBC
PA093185OtherAETNA
PA0007494300003Medicaid
PA5872OtherIBC