Provider Demographics
NPI:1730182189
Name:FOULKEWAYS AT GWYNEDD
Entity type:Organization
Organization Name:FOULKEWAYS AT GWYNEDD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CRISTINZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-283-7002
Mailing Address - Street 1:1120 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19436-1000
Mailing Address - Country:US
Mailing Address - Phone:216-643-2200
Mailing Address - Fax:215-646-2917
Practice Address - Street 1:1120 MEETINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19436-1000
Practice Address - Country:US
Practice Address - Phone:216-643-2200
Practice Address - Fax:215-646-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA144230310400000X
PA060902314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002612OtherHIGHMARK MEDICARE SERVICE
PA5862OtherHIGHMARK BLUE SHIELD
PA5862OtherHIGHMARK BLUE SHIELD