Provider Demographics
NPI:1881738565
Name:SAINT AGNES CONTINUING CARE CENTER
Entity type:Organization
Organization Name:SAINT AGNES CONTINUING CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMOTZER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:215-339-4533
Mailing Address - Street 1:1900 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2304
Mailing Address - Country:US
Mailing Address - Phone:215-339-4223
Mailing Address - Fax:215-339-0482
Practice Address - Street 1:1900 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2304
Practice Address - Country:US
Practice Address - Phone:215-339-4223
Practice Address - Fax:215-339-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1003050510004Medicaid
PAH3919Medicare ID - Type UnspecifiedMEDICARE PLAN IDENTIFIER