Provider Demographics
NPI:1679617963
Name:CHESTNUT HILL REHAB HOSPITAL, LLC
Entity Type:Organization
Organization Name:CHESTNUT HILL REHAB HOSPITAL, LLC
Other - Org Name:MONTGOMERY REHAB HOSPITAL OF CHESTNUT HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-723-3000
Mailing Address - Street 1:1022 MAIN ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5238
Mailing Address - Country:US
Mailing Address - Phone:727-723-3000
Mailing Address - Fax:727-723-3076
Practice Address - Street 1:8601 STENTON AVE
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-8312
Practice Address - Country:US
Practice Address - Phone:215-233-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA010401283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA393032Medicare Oscar/Certification