NPIMap

Organization Active NPI

Willow Terrace

  • Skilled Nursing Facility
  • Phila, PA
National Provider Identifier
1235138587
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
072102 Issued in 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
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

1 Penn Blvd
Phila, PA 19144-1476

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
Albert Einstein Medical12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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": "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phila, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.