Provider Demographics
NPI:1588708655
Name:THE 58TH STREET PRESBYTERIAN HOMES
Entity type:Organization
Organization Name:THE 58TH STREET PRESBYTERIAN HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-724-2218
Mailing Address - Street 1:2050 S 58TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-5932
Mailing Address - Country:US
Mailing Address - Phone:215-724-2218
Mailing Address - Fax:215-724-6924
Practice Address - Street 1:2050 S 58TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-5932
Practice Address - Country:US
Practice Address - Phone:215-724-2218
Practice Address - Fax:215-724-6924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA316170314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007778850002Medicaid
PA395501Medicare ID - Type Unspecified