1396790796 NPI number — ROEPHEL CONVALESCENT CENTER, LLC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396790796 NPI number — ROEPHEL CONVALESCENT CENTER, LLC

Employer Identification Number (EIN):

Provider Organization Name:

ROEPHEL CONVALESCENT CENTER, 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 Other Organization Name:

CINNAMINSON 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:

1396790796

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

08/17/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

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:

610-925-4351

Provider First Line Business Practice Location Address:

1700 WYNWOOD DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CINNAMINSON

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

08077-2440

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

856-829-9000

Provider Business Practice Location Address Fax Number:

856-829-3305

Provider Enumeration Date:

05/23/2006

Authorized Official Last Name:

DROPESKEY

Authorized Official First Name:

JANE

Authorized Official Middle Name:

Authorized Official Title or Position:

CORPORATE MANAGER

Authorized Official Telephone Number:

610-925-4231

• Taxonomy code: 314000000X , with the licence number:  060314 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0005676000 . This is a "AMERIHEALTH-TRADITIONAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 0005676000 . This is a "IBC-MANAGED CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 77 . This is a "ELDER HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 0005676000 . This is a "AMERIHEALTH-MANAGED CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 03010 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 210114 . This is a "US FAMILY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 315047 . This is a "HORIZION - SNF" identifier . This identifiers is of the category "OTHER".
• Identifier: 14401 . This is a "AETNA-HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 23-3476781 . This is a "LOCAL 825" identifier . This identifiers is of the category "OTHER".
• Identifier: 0005676000 . This is a "IBC-TRADITIONAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 000824 . This is a "HORIZION - SUB" identifier . This identifiers is of the category "OTHER".
• Identifier: IY0170 . This is a "HEALTHNET OF PA" identifier . This identifiers is of the category "OTHER".
• Identifier: 4465709 . This is a "UNISYS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".