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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