Provider Demographics
NPI:1922056076
Name:SHANNONDELL, INC.
Entity Type:Organization
Organization Name:SHANNONDELL, INC.
Other - Org Name:REHAB AT SHANNONDELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:RITTENHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-631-1100
Mailing Address - Street 1:5000 SHANNONDELL DR
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-5684
Mailing Address - Country:US
Mailing Address - Phone:610-728-5400
Mailing Address - Fax:610-382-6835
Practice Address - Street 1:5000 SHANNONDELL DR
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-5684
Practice Address - Country:US
Practice Address - Phone:610-728-5400
Practice Address - Fax:610-382-6835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAA00010310400000X
PA17580201314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396101Medicare Oscar/Certification