Promedica Senior Care of Philadelphia PA, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PROMEDICA SENIOR CARE OF PHILADELPHIA PA, LLC

Doing business as

ProMedica Total Rehab (Philadelphia)

Practice address

1526 Lombard St
Philadelphia, PA 19146-1625

Phone

(419) 252-5500

NPI assigned

May 5, 2021

Organization subpart

No

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

Authorized official

Name

Martin David Allen

Title

Director

Phone

(419) 252-5734

Specialties & licenses 1

Addresses

Other names 1

• ProMedica Total Rehab (Philadelphia) Doing business as

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

{
    "created_epoch": "1620172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675900800000",
    "number": "1982287074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436042615",
            "telephone_number": "419-252-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 LOMBARD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191461625",
            "telephone_number": "419-252-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA SENIOR CARE OF PHILADELPHIA PA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-05",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "419-252-5734"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProMedica Total Rehab (Philadelphia)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Judith Prophete, M.D.

• Skilled Nursing Facility in Philadelphia, PA
• Providers in Philadelphia, 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 Feb 9, 2023; 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.