Provider Demographics
NPI:1689699936
Name:CROZER-CHESTER MEDICAL CENTER
Entity Type:Organization
Organization Name:CROZER-CHESTER MEDICAL CENTER
Other - Org Name:CKHS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-638-1515
Mailing Address - Street 1:200 W SPROUL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2016
Mailing Address - Country:US
Mailing Address - Phone:610-284-0700
Mailing Address - Fax:
Practice Address - Street 1:200 W SPROUL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2016
Practice Address - Country:US
Practice Address - Phone:610-284-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA391567251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007725660009Medicaid
PA391567Medicare ID - Type Unspecified