Provider Demographics
NPI:1295753978
Name:STAPELEY HALL
Entity type:Organization
Organization Name:STAPELEY HALL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:215-844-0700
Mailing Address - Street 1:6300 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2596
Mailing Address - Country:US
Mailing Address - Phone:215-844-0700
Mailing Address - Fax:215-991-7124
Practice Address - Street 1:6300 GREENE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2596
Practice Address - Country:US
Practice Address - Phone:215-844-0700
Practice Address - Fax:215-991-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA455502313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010355390002Medicaid
395715Medicare Oscar/Certification