Basic Information
| Provider Information | |||||||||
| NPI: | 1700811668 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TENET HEALTHSYSTEM GRADUATE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GRADUATE HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 828120 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191828120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152553152 | ||||||||
| FaxNumber: | 2158932302 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 LOMBARD ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191468400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158932000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 12/05/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RABE | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF TAXATION, TENET HEALTHCARE | ||||||||
| AuthorizedOfficialTelephone: | 4698932530 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TENET HEALTHSYSTEM GRADUATE, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 073001 | PA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.