Provider Demographics
NPI:1023168283
Name:BALA NURSING & RET CNTR LTD PTRSHP FORD RD CORP
Entity type:Organization
Organization Name:BALA NURSING & RET CNTR LTD PTRSHP FORD RD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-877-5400
Mailing Address - Street 1:4001 FORD RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2833
Mailing Address - Country:US
Mailing Address - Phone:215-877-5400
Mailing Address - Fax:215-871-3110
Practice Address - Street 1:4001 FORD RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2833
Practice Address - Country:US
Practice Address - Phone:215-877-5400
Practice Address - Fax:215-871-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA041402314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011856700001Medicaid
PABLUE CROSSOtherBLUE CROSS
PA19203OtherSENIOR PARTNERS
PA606828OtherAETNA PROVIDER NUMBER
PA8133OtherELDER HEALTH
PAKEYSTONE MERCYOther1059563
PAKEYSTONE MERCYOther1059563