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LIFE ST. MARY NPI 1003052820


NPI Information

NPI: 1003052820
Provider Name: LIFE ST. MARY
Classification: Program of All-Inclusive Care for the Elderly (PACE) Provider Organization - 251T00000X
Entity Type: Organization

CLIA Number: 39D2002622

Address:
2500 INTERPLEX DRIVE
TREVOSE, PA
ZIP 19053
Phone: (215) 710-6114
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LIFE ST. MARY is a program of all inclusive care for the elderly pace provider organization in Trevose, PA. The provider is a PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services). The following characteristics also apply to a PACE organization. It must: have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights. LIFE ST. MARY NPI is 1003052820. The provider is registered as an organization entity type.

The provider's business location address is:

2500 INTERPLEX DRIVE
TREVOSE, PA
ZIP 19053-943
Phone: (215) 710-6114

The provider's authorized official is Emily Amerman .
The authorized official title is Executive Director and has the following contact phone number (215) 710-6114.

The CLIA number assigned to this NPI record is 39D2002622 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/29/2008 and was last updated on 4/21/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QA0600XClinic/CenterAdult Day CareNo
2251T00000XProgram of All-Inclusive Care for the Elderly (PACE) Provider OrganizationYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1H6551OTHERCMS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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