Provider Demographics
NPI:1184619736
Name:HUMANGOOD PENNSYLVANIA
Entity type:Organization
Organization Name:HUMANGOOD PENNSYLVANIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:VANGELISTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-463-0893
Mailing Address - Street 1:2000 JOSHUA ROAD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2430
Mailing Address - Country:US
Mailing Address - Phone:610-828-4848
Mailing Address - Fax:610-834-6556
Practice Address - Street 1:1515 THE FAIRWAY
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1435
Practice Address - Country:US
Practice Address - Phone:215-885-6800
Practice Address - Fax:215-885-4560
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMANGOOD PENNSYLVANIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-20
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
PA182102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007453170003Medicaid
PA1007453170003Medicaid
PA395321Medicare UPIN