Organization
WILLOW TERRACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL RUSSO (CORP. DIRECTOR OF FINANCE)
(215) 456-6611
Entity
Organization
Contact information
Practice address
1 PENN BLVD, PHILA, PA 19144-1476
(215) 456-6611
(215) 457-4304
Mailing address
1 PENN BLVD, PHILA, PA 19144-1476
(215) 456-6611
(215) 457-4304
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
072102
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007544140014
—
PA
Enumeration date
07/19/2005
Last updated
08/22/2020
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