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 |
| 1 | 314000000X | Skilled Nursing Facility | | 140202 | PENNSYLVANIA | Yes |
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 |
| 1 | 0006233000 | OTHER | | INDEPENDENCE BLUE CROSS |
| 2 | 24773 | OTHER | | HEALTH PARTNERS |
| 3 | 001426 | OTHER | | HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY, INC. |
| 4 | 10424 | OTHER | | BRAVO BY ELDER HEALTH HMO INC. |
| 5 | 71-00397 | OTHER | | UNITED HEALTHCARE |
| 6 | ========= | OTHER | | HEALTH CARE PAYERS COALITION |
| 7 | 100773100003 | MEDICAID | PENNSYLVANIA | |
| 8 | 001426 | OTHER | | HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY, INC. - PART B REHAB |
| 9 | 1050416 | OTHER | | INDEPENDENCE BLUE CROSS -KEYSTONE MERCY |
| 10 | 260262 | OTHER | | HEALTH AMERICA PENNSYLVANIA, INC. |
| 11 | ========= | OTHER | | CONSUMER HEALTH NETWORK (CHN SOLUTIONS) |
| 12 | ========= | OTHER | | GREAT-WEST HEALTHCARE |
| 13 | 588883 | OTHER | | AETNA-HMO |
| 14 | 395010 | OTHER | | HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY, INC. - SNF |
| 15 | 0006233000 | OTHER | | AMERIHEALTH |
| 16 | 0074814701 | OTHER | | UNITED HEALTHCARE - AMERICHOICE |
| 17 | 001036 | OTHER | | HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY, INC. - SUB |
| 18 | ========= | OTHER | | AETNA-NONHMO |
| 19 | ========= | OTHER | | HEALTH NET FEDERAL SERVICES |
