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Organization
EVANGELICAL MANOR
Active
Organization
EVANGELICAL MANOR
Active
Other names
Wesley Enhanced Living at Pennypack Park
Organization subpart
No
Provider details
NPI number
Authorized official
RONNIE CONNER (CORPORATE DIRECTOR OF RCM)
(267) 885-6232
Entity
Organization
Contact information
Practice address
8401 ROOSEVELT BLVD, PHILADELPHIA, PA 19152-2034
(215) 624-5800
(215) 335-1477
Mailing address
8401 ROOSEVELT BLVD, PHILADELPHIA, PA 19152-2034
(215) 624-5800
(215) 624-7994
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
311202
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005920000
IBC PROVIDER ID
PA
05
—
0007449700001
—
PA
01
—
2123484
AETNA PROVIDER ID
PA
Enumeration date
10/04/2005
Last updated
05/28/2026
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