NPIMap

Organization Active NPI

St. Agnes Continuing Care Center

  • PACE Provider Organization
  • Philadelphia, PA
National Provider Identifier
1174881627
Registry record updated May 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
License
H3919 Issued in PA
Legal business name
ST. AGNES CONTINUING CARE CENTER
Practice address
1930 S Broad St
Philadelphia, PA 19145-2328
Phone
(215) 339-4563
NPI assigned
May 2, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Joseph Bradley, CPA
Title
SVP of Finance
Phone
(610) 567-6770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X H3919 PA Primary

Addresses

Primary practice location

1930 S Broad St
Philadelphia, PA 19145-2328

Mailing address

1930 S Broad St
Philadelphia, PA 19145-2328
Phone (215) 339-4563

Other identifiers 1

IdentifierTypeStateIssuer
H3919OtherPAH NUMBER

Other names 1

  • Mercy LIFE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Saint Agnes Continuing Care Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335916800000",
    "number": "1174881627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191452328",
            "telephone_number": "215-339-4563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191452328",
            "telephone_number": "215-339-4563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. AGNES CONTINUING CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-02",
        "last_updated": "2012-05-02",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "SVP OF FINANCE",
        "authorized_official_telephone_number": "610-567-6770",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "PA",
            "license": "H3919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "H NUMBER",
            "identifier": "H3919",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy LIFE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.