Provider Demographics
NPI:1215096102
Name:MAIN LINE ADULT DAY CENTER
Entity type:Organization
Organization Name:MAIN LINE ADULT DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SULIMAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-353-6642
Mailing Address - Street 1:119 RADNOR ST
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3506
Mailing Address - Country:US
Mailing Address - Phone:610-527-4220
Mailing Address - Fax:610-527-6071
Practice Address - Street 1:119 RADNOR ST
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3506
Practice Address - Country:US
Practice Address - Phone:610-527-4220
Practice Address - Fax:610-527-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA281330261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000050820002Medicaid
PA1000050820003Medicaid