Provider Demographics
NPI:1922005271
Name:GREENLEAF NURSING AND CONVALESCENT, INC.
Entity Type:Organization
Organization Name:GREENLEAF NURSING AND CONVALESCENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JMAES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MULROY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:610-630-2400
Mailing Address - Street 1:400 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4883
Mailing Address - Country:US
Mailing Address - Phone:215-348-2980
Mailing Address - Fax:215-348-0128
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4883
Practice Address - Country:US
Practice Address - Phone:215-348-2980
Practice Address - Fax:215-348-0128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCORDHEALTH SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-01
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA070102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1040249OtherKEYSTONE MERCY
PA5930OtherINDEPENDENCE BLUE CROSS
PA53020OtherUS HEALTH CARE
PA0007910950001Medicaid
PA005930OtherBLUE CROSS HMO
PA5930OtherINDEPENDENCE BLUE CROSS