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Organization Active NPI

Foulkeways at Gwynedd

  • Skilled Nursing Facility
  • Gwynedd, PA
National Provider Identifier
1730182189
Registry record updated Nov 5, 2007
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Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
060902 Issued in PA
Legal business name
FOULKEWAYS AT GWYNEDD
Practice address
1120 Meetinghouse Rd
Gwynedd, PA 19436-1000
Phone
(216) 643-2200
Fax
(215) 646-2917
NPI assigned
May 31, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2007

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

Authorized official

Name
Mrs. Edna Marie Cristinzio
Title
Chief Financial Officer
Phone
(215) 283-7002

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 144230 PA
Skilled Nursing Facility 314000000X 060902 PA Primary

Addresses

Primary practice location

1120 Meetinghouse Rd
Gwynedd, PA 19436-1000

Mailing address

1120 Meetinghouse Rd
Gwynedd, PA 19436-1000
Phone (216) 643-2200

Other identifiers 2

IdentifierTypeStateIssuer
002612OtherPAHIGHMARK MEDICARE SERVICE
5862OtherPAHIGHMARK BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040422001365 PA Part B Supplier - Clinic/Group Practice 4082600283 Receives reassigned benefits from 6 practitioners
Practice locations: Gwynedd, PA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Foulkeways HospiceGwynedd, PA, CCN 391749 Hospice 5% Or Greater Direct Ownership Interest Sep 1, 2011

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194220800000",
    "number": "1730182189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 MEETINGHOUSE RD",
            "city": "GWYNEDD",
            "state": "PA",
            "postal_code": "194361000",
            "telephone_number": "216-643-2200",
            "fax_number": "215-646-2917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 MEETINGHOUSE RD",
            "city": "GWYNEDD",
            "state": "PA",
            "postal_code": "194361000",
            "telephone_number": "216-643-2200",
            "fax_number": "215-646-2917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOULKEWAYS AT GWYNEDD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-31",
        "last_updated": "2007-11-05",
        "status": "A",
        "authorized_official_last_name": "CRISTINZIO",
        "authorized_official_first_name": "EDNA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "215-283-7002",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "PA",
            "license": "144230",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "060902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK MEDICARE SERVICE",
            "identifier": "002612",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "5862",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gwynedd, PA

Sources for this page

Verify at the official NPI Registry.