Organization
ST. AGNES CONTINUING CARE CENTER
Active
Other names
Mercy LIFE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH BRADLEY CPA (SVP OF FINANCE)
(610) 567-6770
Entity
Organization
Contact information
Practice address
1930 S BROAD ST, PHILADELPHIA, PA 19145-2328
(215) 339-4563
Mailing address
1930 S BROAD ST, PHILADELPHIA, PA 19145-2328
(215) 339-4563
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
H3919
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H3919
H NUMBER
PA
Enumeration date
05/02/2012
Last updated
05/02/2012
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