Provider Demographics
NPI:1720041874
Name:GREEN ACRES REHABILITATION & NURSING CENTER
Entity Type:Organization
Organization Name:GREEN ACRES REHABILITATION & NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-357-6055
Mailing Address - Street 1:4 IVYBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:IVYLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18974-1700
Mailing Address - Country:US
Mailing Address - Phone:215-357-6055
Mailing Address - Fax:215-357-6968
Practice Address - Street 1:1401 IVY HILL RD
Practice Address - Street 2:
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19150-1516
Practice Address - Country:US
Practice Address - Phone:215-357-6055
Practice Address - Fax:215-357-6968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA591902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
13111OtherAETNA US HEALTHCARE
25206OtherGREEN ACRES
PA0095121400001Medicaid
1027618OtherKEYSTONE MERCY HEALTHPLAN
0005891000OtherKEYSTONE 65
PAPA235OtherELDERHEALTH
0005891000OtherBLUE CROSS
0095121401OtherAMERICHOICE
PA395525Medicare ID - Type UnspecifiedFI = MUTUAL OF OMAHA