Organization
EVANGELICAL MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUZANNE LACHMAN NHA (EXECUTIVE DIRECTOR)
(215) 624-5800
Entity
Organization
Contact information
Practice address
8401 ROOSEVELT BLVD, PHILADELPHIA, PA 19152-2034
(215) 624-5800
(215) 335-1477
Mailing address
928 JAYMOR RD, SUITE B-150, SOUTHAMPTON, PA 18966-3826
(215) 354-9586
(215) 354-1435
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
08/22/2020
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