Provider Demographics
NPI:1962530683
Name:HOLY FAMILY HOME
Entity type:Organization
Organization Name:HOLY FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:215-729-5153
Mailing Address - Street 1:5300 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-4929
Mailing Address - Country:US
Mailing Address - Phone:215-729-5153
Mailing Address - Fax:215-727-5332
Practice Address - Street 1:5300 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-4929
Practice Address - Country:US
Practice Address - Phone:215-729-5153
Practice Address - Fax:215-727-5332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA144930310400000X
PA341602313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007471860001Medicaid
PA0007471860001Medicaid
PA39-5637Medicare ID - Type Unspecified
PA39-5637Medicare PIN