NPIMap

Willow Terrace

Organization Active NPI Skilled Nursing Facility · Phila, PA

NPI 1235138587 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1235138587
Entity type
Organization (NPI type 2)
Primary specialty
Skilled Nursing Facility 314000000X
License
072102 (PA)
Legal business name
WILLOW TERRACE
Practice address
1 Penn Blvd
Phila, PA 19144-1476
Phone
(215) 456-6611
Fax
(215) 457-4304
NPI assigned
Jul 19, 2005
Organization subpart
No

Authorized official

Name
Mr. Samuel Russo
Title
Corp. Director of Finance
Phone
(215) 456-6611

Corporate family (same tax ID) 11

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

National Provider Directory

Tax ID family
Albert Einstein Medical Center (12 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 072102 PA Yes

Addresses

Primary practice location

1 Penn Blvd
Phila, PA 19144-1476

Mailing address

1 Penn Blvd
Phila, PA 19144-1476
Phone (215) 456-6611

Other identifiers

IdentifierTypeStateIssuer
1007544140014MedicaidPA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235138587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PENN BLVD",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191441476",
            "telephone_number": "215-456-6611",
            "fax_number": "215-457-4304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PENN BLVD",
            "city": "PHILA",
            "state": "PA",
            "postal_code": "191441476",
            "telephone_number": "215-456-6611",
            "fax_number": "215-457-4304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW TERRACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RUSSO",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "CORP. DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "215-456-6611",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "072102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007544140014",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phila, PA

All providers in Phila, PA · Skilled Nursing Facility in Pennsylvania

Sources for this page

Verify at the official NPI Registry.