Provider Demographics
NPI:1366709289
Name:RELIANT AUDUBON HOLDINGS LLC
Entity type:Organization
Organization Name:RELIANT AUDUBON HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:MYZAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-558-3700
Mailing Address - Street 1:3601 ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-3228
Mailing Address - Country:US
Mailing Address - Phone:215-558-3700
Mailing Address - Fax:215-558-3701
Practice Address - Street 1:125 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1808
Practice Address - Country:US
Practice Address - Phone:717-626-0211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility