Provider Demographics
NPI:1285621722
Name:GWYNEDD SQUARE CENTER FOR NURSING AND CONVALESCENT CARE
Entity type:Organization
Organization Name:GWYNEDD SQUARE CENTER FOR NURSING AND CONVALESCENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-699-5000
Mailing Address - Street 1:773 SUMNEYTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5301
Mailing Address - Country:US
Mailing Address - Phone:215-699-5000
Mailing Address - Fax:215-699-9409
Practice Address - Street 1:773 SUMNEYTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5301
Practice Address - Country:US
Practice Address - Phone:215-699-5000
Practice Address - Fax:215-699-9409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA075002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007574870001Medicaid
PA0007574870001Medicaid