Provider Demographics
NPI:1902378136
Name:MADLYN AND LEONARD ABRAMSON CENTER FOR JEWISH LIFE
Entity Type:Organization
Organization Name:MADLYN AND LEONARD ABRAMSON CENTER FOR JEWISH LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:IRVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-371-1802
Mailing Address - Street 1:1425 HORSHAM RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1320
Mailing Address - Country:US
Mailing Address - Phone:215-371-3000
Mailing Address - Fax:
Practice Address - Street 1:12003 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2152
Practice Address - Country:US
Practice Address - Phone:215-371-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10007600910071Medicaid