Provider Demographics
NPI:1154600500
Name:FOULKEWAYS AT GWYNEDD
Entity type:Organization
Organization Name:FOULKEWAYS AT GWYNEDD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CRISTINZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-283-7002
Mailing Address - Street 1:1120 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19436-1000
Mailing Address - Country:US
Mailing Address - Phone:215-643-2200
Mailing Address - Fax:215-591-2286
Practice Address - Street 1:1120 MEETINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19436-1000
Practice Address - Country:US
Practice Address - Phone:215-643-2200
Practice Address - Fax:215-591-2286
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOULKEWAYS AT GWYNEDD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
5862OtherHIGHMARK BLUE SHIELD
002612OtherHIGHMARK MEDICARE SERVICE
395235Medicare Oscar/Certification