1124155239 NPI number — SENIOR CARE CENTERS OF AMERICA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124155239 NPI number — SENIOR CARE CENTERS OF AMERICA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENIOR CARE CENTERS OF AMERICA, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1124155239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 NESHAMINY INTERPLEX
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
TREVOSE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19053-6964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-642-6600
Provider Business Mailing Address Fax Number:
215-642-6610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
556A LIPPONCOTT DRIVE
Provider Second Line Business Practice Location Address:
BLDG B
Provider Business Practice Location Address City Name:
MARLTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-988-3250
Provider Business Practice Location Address Fax Number:
856-988-3251
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOCKENBURY
Authorized Official First Name:
DEBORA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTRACTS MANAGER
Authorized Official Telephone Number:
215-642-6600

Provider Taxonomy Codes

  • Taxonomy code: 385H00000X , with the licence number:  158100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0545449 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5561779 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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