1396708467 NPI number — RICHBORO SNF LLC

Table of content: (NPI 1396708467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396708467 NPI number — RICHBORO SNF LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHBORO SNF 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:
DBA RICHBORO CARE 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:
1396708467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4597 ROUTE 9 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07731-3382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-942-1344
Provider Business Mailing Address Fax Number:
215-357-6968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
253 TWINING FORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHBORO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18954-1843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-357-2032
Provider Business Practice Location Address Fax Number:
215-357-6968
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZUCKER
Authorized Official First Name:
YOSSI
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
866-942-1344

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  032802 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0005752000 . This is a "KEYSTONE 65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57586 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005752000 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17270 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0011293400001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0112934001 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1045041 . This is a "KEYSTONE MERCY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".




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