Provider Demographics
NPI:1487312344
Name:MADISON'S PLACE LLC
Entity type:Organization
Organization Name:MADISON'S PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COGDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-626-0482
Mailing Address - Street 1:34 N WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:ALDAN
Mailing Address - State:PA
Mailing Address - Zip Code:19018-3836
Mailing Address - Country:US
Mailing Address - Phone:610-626-0482
Mailing Address - Fax:
Practice Address - Street 1:34 N WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:ALDAN
Practice Address - State:PA
Practice Address - Zip Code:19018-3836
Practice Address - Country:US
Practice Address - Phone:610-357-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care