# IMMACULATE MARY HOME

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CATHOLIC HEALTH CARE SERVICES
- **Other names:** Immaculate Mary Home
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1205810587
- **Legal business name:** CATHOLIC HEALTH CARE SERVICES
- **Authorized official:** MR. MICHAEL CZEKNER (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (215) 368-0900

## Contact information

- **Practice address:** 2990 HOLME AVE, PHILADELPHIA, PA 19136-1830
- **Practice address phone:** (215) 335-2100
- **Practice address fax:** (215) 331-9105
- **Mailing address:** 2990 HOLME AVE, PHILADELPHIA, PA 19136-1830
- **Mailing address phone:** (215) 335-2100
- **Mailing address fax:** (215) 331-9105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 090902 | PA | Yes |

## Other

- **Enumeration date:** 12/01/2005
- **Last updated:** 06/16/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0007570930002 | — | PA |
| 01 | — | 0556883 | AETNA | PA |
| 01 | — | 395338 | IBC KEYSTONE | PA |