Provider Demographics
NPI:1811994460
Name:SACRED HEART MANOR, INC
Entity type:Organization
Organization Name:SACRED HEART MANOR, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER FIDELIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA, RN
Authorized Official - Phone:215-438-5268
Mailing Address - Street 1:6445 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2345
Mailing Address - Country:US
Mailing Address - Phone:215-438-5268
Mailing Address - Fax:215-951-0798
Practice Address - Street 1:6445 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2345
Practice Address - Country:US
Practice Address - Phone:215-438-5268
Practice Address - Fax:215-951-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA185860310400000X
PA191802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007569800002Medicaid
PA0007569800002Medicaid