IMMACULATE MARY HOME NPI 1205810587

NPI Information

  • NPI: 1205810587
  • Provider Name: IMMACULATE MARY HOME
  • Classification: Skilled Nursing Facility - 314000000X
  • Entity Type: Organization
  • Doing Business As: IMMACULATE MARY HOME
  • Address: 2990 HOLME AVE
    PHILADELPHIA, PA
    ZIP 19136
  • Phone: (215) 335-2100

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NPI Details

IMMACULATE MARY HOME is a skilled nursing facility in Philadelphia, PA. The provider is (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. IMMACULATE MARY HOME NPI is 1205810587. The provider is registered as an organization entity type.
The provider Is Doing Business As Immaculate Mary Home.

The provider's business location address is:

2990 HOLME AVE
PHILADELPHIA, PA
ZIP 19136-830
Phone: (215) 335-2100
Fax: (215) 331-9105

The provider's authorized official is Michael Czekner .
The authorized official title is Chief Financial Officer and has the following contact phone number (215) 368-0900.

The enumeration date for this NPI number is 12/1/2005 and was last updated on 6/16/2008.

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
1314000000XSkilled Nursing Facility090902PENNSYLVANIAYes

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
1395338OTHERPENNSYLVANIAIBC KEYSTONE
20556883OTHERPENNSYLVANIAAETNA
3395338MEDICARE ID-TYPE UNSPECIFIEDPENNSYLVANIA
40007570930002MEDICAIDPENNSYLVANIA

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: 3/30/2025

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