1447491212 NPI number — 3089 BAYSHORE ROAD OPERATIONS LLC

Table of content: (NPI 1447491212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447491212 NPI number — 3089 BAYSHORE ROAD OPERATIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
3089 BAYSHORE ROAD OPERATIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VICTORIA MANOR NURSING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447491212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNETT SQUARE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19348-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-925-4436
Provider Business Mailing Address Fax Number:
610-347-4099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3809 BAYSHORE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CAPE MAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08204-3259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-898-0677
Provider Business Practice Location Address Fax Number:
609-898-1186
Provider Enumeration Date:
03/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WILKINSON
Authorized Official First Name:
MARCELLA
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE DIRECTOR
Authorized Official Telephone Number:
610-925-4045

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  060508 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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