Provider Demographics
NPI:1902895550
Name:JENNER'S POND INC.
Entity type:Organization
Organization Name:JENNER'S POND INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-869-6802
Mailing Address - Street 1:2000 GREENBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9485
Mailing Address - Country:US
Mailing Address - Phone:610-869-6770
Mailing Address - Fax:
Practice Address - Street 1:2000 GREENBRIAR LN
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9485
Practice Address - Country:US
Practice Address - Phone:610-869-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMPSON SENIOR SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-17
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA157002013140N1450X
PA101500310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7972591OtherPPO
PA3975364OtherAETNA
PA3975364OtherAETNA