Provider Demographics
NPI:1275660656
Name:MAIN LINE HOSPITALS, INC.
Entity type:Organization
Organization Name:MAIN LINE HOSPITALS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-337-2029
Mailing Address - Street 1:240 N RADNOR CHESTER RD
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5170
Mailing Address - Country:US
Mailing Address - Phone:484-337-1814
Mailing Address - Fax:
Practice Address - Street 1:600 ABBOTT DR
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-4317
Practice Address - Country:US
Practice Address - Phone:888-227-3898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA110260261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001101000OtherIBC - ADTC
PA1007354280017Medicaid
0001443OtherADTC AETNA NON HMO
390139OtherADTC AMERIHEALTH
0001101000OtherIBC - ADTC