Green Acres Rehabilitation & Nursing Center

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

591902 Issued in PA

Legal business name

GREEN ACRES REHABILITATION & NURSING CENTER

Practice address

1401 Ivy Hill Rd
Wyndmoor, PA 19150-1516

Phone

(215) 357-6055

Fax

(215) 357-6968

NPI assigned

Apr 10, 2006

Organization subpart

No

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

Authorized official

Name

Allen Segal

Title

President

Phone

(215) 357-6055

Specialties & licenses 1

Addresses

Other identifiers 8

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1720041874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 IVYBROOK BLVD",
            "city": "IVYLAND",
            "state": "PA",
            "postal_code": "189741700",
            "telephone_number": "215-357-6055",
            "fax_number": "215-357-6968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 IVY HILL RD",
            "city": "WYNDMOOR",
            "state": "PA",
            "postal_code": "191501516",
            "telephone_number": "215-357-6055",
            "fax_number": "215-357-6968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN ACRES REHABILITATION & NURSING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-10",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SEGAL",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-357-6055"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "591902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "13111",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREEN ACRES",
            "identifier": "25206",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0095121400001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE MERCY HEALTHPLAN",
            "identifier": "1027618",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE 65",
            "identifier": "0005891000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ELDERHEALTH",
            "identifier": "PA235",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0005891000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE",
            "identifier": "0095121401",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Wyndmoor, PA
• Providers in Wyndmoor, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.