Organization
COUNTY OF CHESTER
Active
Other names
Pocopson Home
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND A LARSON (ADMINISTRATOR)
(610) 793-1212
Entity
Organization
Contact information
Practice address
1695 LENAPE RD, WEST CHESTER, PA 19382-6801
(610) 793-1212
(610) 793-2493
Mailing address
1695 LENAPE RD, WEST CHESTER, PA 19382-6800
(610) 793-1212
(610) 793-2493
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
162002
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005967
KEYSTONE EAST PROVIDER #
PA
01
—
0445390001
NSC # DMERCA MC-B'S
PA
05
—
100765534-0002
—
PA
01
—
100765534-0004
2ND PROMISE# PA MEDICAID
PA
01
—
5967
BLUE CROSS PROVIDER#
PA
Enumeration date
07/18/2005
Last updated
07/21/2022
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