# CENTENNIAL HEALTHCARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Centennial Healthcare and Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861760522
- **Authorized official:** MR. COLEV J GESTETNER (MANAGING MEMBER)
- **Authorized official phone:** (215) 477-1170

## Contact information

- **Practice address:** 4400 W GIRARD AVE, PHILADELPHIA, PA 19104-1002
- **Practice address phone:** (215) 477-1170
- **Practice address fax:** (215) 473-8290
- **Mailing address:** 4400 W GIRARD AVE, PHILADELPHIA, PA 19104-1002
- **Mailing address phone:** (215) 477-1170
- **Mailing address fax:** (215) 473-8290

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 193902 | PA | Yes |

## Other

- **Enumeration date:** 12/09/2011
- **Last updated:** 12/09/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 395950 | MEDICARE PROVIDER NUMBER | PA |