Provider Demographics
NPI:1851745566
Name:KENSINGTON HOSPITAL
Entity Type:Organization
Organization Name:KENSINGTON HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:215-426-8100
Mailing Address - Street 1:2100 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-1705
Mailing Address - Country:US
Mailing Address - Phone:215-426-8100
Mailing Address - Fax:267-861-6410
Practice Address - Street 1:2100 N FRONT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-1705
Practice Address - Country:US
Practice Address - Phone:215-426-8100
Practice Address - Fax:267-861-6410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENSINGTON HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-19
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007717290021Medicaid