Provider Demographics
NPI:1982680633
Name:SAINT MARTHA MANOR
Entity Type:Organization
Organization Name:SAINT MARTHA MANOR
Other - Org Name:ST MARTHA MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CZEKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-368-0900
Mailing Address - Street 1:470 MANOR AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2545
Mailing Address - Country:US
Mailing Address - Phone:610-873-8490
Mailing Address - Fax:610-873-5684
Practice Address - Street 1:470 MANOR AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2545
Practice Address - Country:US
Practice Address - Phone:610-873-8490
Practice Address - Fax:610-873-5684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA457402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011860410001Medicaid
PA523892OtherAETNA
PA5683OtherIOC/KEYSTONE
PA0011860410001Medicaid