NPIMap

Organization Active NPI

Immaculate Mary Home

  • Skilled Nursing Facility
  • Philadelphia, PA
National Provider Identifier
1205810587
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
090902 Issued in PA
Legal business name
IMMACULATE MARY HOME
Practice address
2990 Holme Ave
Philadelphia, PA 19136-1830
Phone
(215) 335-2100
Fax
(215) 331-9105
NPI assigned
Dec 1, 2005
Organization subpart
Yes
Parent organization
CATHOLIC HEALTH CARE SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

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

Authorized official

Name
Mr. Michael Czekner
Title
Chief Financial Officer
Phone
(215) 368-0900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 090902 PA Primary

Addresses

Primary practice location

2990 Holme Ave
Philadelphia, PA 19136-1830

Mailing address

2990 Holme Ave
Philadelphia, PA 19136-1830
Phone (215) 335-2100

Other identifiers 3

IdentifierTypeStateIssuer
0007570930002MedicaidPA
0556883OtherPAAETNA
395338OtherPAIBC KEYSTONE

Other names 1

  • Immaculate Mary Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
2990 Holme Operating LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1205810587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2990 HOLME AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191361830",
            "telephone_number": "215-335-2100",
            "fax_number": "215-331-9105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 HOLME AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191361830",
            "telephone_number": "215-335-2100",
            "fax_number": "215-331-9105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMACULATE MARY HOME",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CATHOLIC HEALTH CARE SERVICES",
        "enumeration_date": "2005-12-01",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "CZEKNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "215-368-0900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "090902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0007570930002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0556883",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IBC KEYSTONE",
            "identifier": "395338",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Immaculate Mary Home",
            "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 Jun 16, 2008; 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.