Provider Demographics
NPI:1699720433
Name:EDELLA STREET ASSOCIATES
Entity type:Organization
Organization Name:EDELLA STREET ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORITE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DROPESKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-925-4231
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:610-925-4436
Mailing Address - Fax:610-925-4351
Practice Address - Street 1:100 EDELLA RD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1628
Practice Address - Country:US
Practice Address - Phone:570-586-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA053202314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAIY0169OtherHEALTHNET OF PA
PA39-5701OtherBC OF NORTHEASTERN PA
PA82284OtherAETNA-HMO
PA21349OtherGEISINGER HEALTH PLANS
NY317116OtherUS FAMILY HEALTH PLAN
PA0010076320001Medicaid
PA080314OtherFIRST PRIORITY
NJ=========OtherCONSUMER HEALTH NETWORK
PA39-5701OtherBC OF NORTHEASTERN PA
PA=========OtherAETNA-NONHMO
PA0010076320001Medicaid
PA080314OtherFIRST PRIORITY