IMMACULATE MARY HOME
NPI 1205810587
Skilled Nursing Facility in Philadelphia, PA

Active since December 01, 2005CLIA 39D0202602 · Waiver
2990 HOLME AVE, PHILADELPHIA, PA 19136(215) 335-2100(215) 331-9105 Get Directions Write a Review

NPPES record last updated: June 16, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Immaculate Mary Home NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IMMACULATE MARY HOME (NPI 1205810587) is a healthcare organization registered as a skilled nursing facility in Philadelphia, Pennsylvania and active in the NPI registry since December 2005. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Michael Czekner, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1205810587
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameIMMACULATE MARY HOME
Location Address2990 HOLME AVEPhiladelphia, PA 19136-1830
Mailing Address2990 Holme AvePhiladelphia, PA 19136-1830 · (215) 335-2100 · Fax (215) 331-9105
Fax(215) 331-9105
Organization SubpartYesParent: Catholic Health Care Services
Authorized OfficialMichael CzeknerChief Financial Officer · (215) 368-0900
Enumeration DateDecember 1, 2005
Last NPPES UpdateJune 16, 2008
NPI 1205810587 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License Licensed in PA · 090902
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
2990 HOLME AVE, Philadelphia, PA 19136

Other Names 1

Doing Business AsImmaculate Mary Home

Other Identifiers 4

Other395338PA · Ibc Keystone
Other0556883PA · Aetna
Medicare ID-Type Unspecified395338PA
Medicaid0007570930002PA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 39D0202602

Immaculate Mary Home · Philadelphia, PA
Active · expires Aug 31, 2026
CLIA Number39D0202602
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorDr. Brian B. Kimmel
Laboratory Phone(215) 992-1824
Laboratory LocationImmaculate Mary Home2990 Holme Avenue, Philadelphia, PA 19136
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physical Therapist
2990 HOLME AVE
PHILADELPHIA, PA 19136
Physical Therapist
2990 HOLME AVE
PHILADELPHIA, PA 19136
Occupational Therapist
2990 HOLME AVE, IMMACULATE MARY HOME
PHILADELPHIA, PA 19136
Speech-Language Pathologist
2990 HOLME AVE, IMMACULATE MARY HOME
PHILADELPHIA, PA 19136
Physical Therapy Assistant
2990 HOLME AVE, IMMACULATE MARY HOME
PHILADELPHIA, PA 19136
Skilled Nursing Facility
2990 HOLME AVE
PHILADELPHIA, PA 19136
Physical Medicine & Rehabilitation
2990 HOLME AVE
PHILADELPHIA, PA 19136
Occupational Therapist
2990 HOLME AVE
PHILADELPHIA, PA 19136

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Immaculate Mary Home's NPI number?

The NPI number for Immaculate Mary Home is 1205810587. It was assigned to this organization in the NPPES registry on December 1, 2005.

Where is Immaculate Mary Home located?

Immaculate Mary Home is located at 2990 Holme Ave, Philadelphia, PA 19136. The listed phone number is (215) 335-2100.

What is Immaculate Mary Home's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Immaculate Mary Home hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 39D0202602) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Immaculate Mary Home was last updated on June 16, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.