1649726571 NPI number — REHAB EXCELLENCE CENTER, LLC

Table of content: (NPI 1649726571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649726571 NPI number — REHAB EXCELLENCE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHAB EXCELLENCE 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's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1649726571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6981 N PARK DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
PENNSAUKEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08109-4205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-910-1200
Provider Business Mailing Address Fax Number:
856-910-7800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 ROUTE 168
Provider Second Line Business Practice Location Address:
SUITE A-8
Provider Business Practice Location Address City Name:
TURNERSVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08012-3233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-227-1440
Provider Business Practice Location Address Fax Number:
856-227-1446
Provider Enumeration Date:
08/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KUSS
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
856-910-1200

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X , with the licence number: 40QA01690700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 070451 . This is a "PTAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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