Organization
IMMACULATE MARY HOME
Active
Parent organization
CATHOLIC HEALTH CARE SERVICES
Other names
Immaculate Mary Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
CATHOLIC HEALTH CARE SERVICES
Authorized official
MR. MICHAEL CZEKNER (CHIEF FINANCIAL OFFICER)
(215) 368-0900
Entity
Organization
Contact information
Practice address
2990 HOLME AVE, PHILADELPHIA, PA 19136-1830
(215) 335-2100
(215) 331-9105
Mailing address
2990 HOLME AVE, PHILADELPHIA, PA 19136-1830
(215) 335-2100
(215) 331-9105
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
090902
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007570930002
—
PA
01
—
0556883
AETNA
PA
01
—
395338
IBC KEYSTONE
PA
Enumeration date
12/01/2005
Last updated
06/16/2008
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