1558316828 NPI number — BURLINGTON WOODS CONVALESCENT CENTER, INC.

Table of content: (NPI 1558316828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558316828 NPI number — BURLINGTON WOODS CONVALESCENT CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURLINGTON WOODS CONVALESCENT CENTER, 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:
1558316828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
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:
610-925-4366
Provider Business Mailing Address Fax Number:
610-925-4351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 SUNSET RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08016-4153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-387-3620
Provider Business Practice Location Address Fax Number:
609-387-1704
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  060301 , 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)

  • Identifier: 10421 . This is a "ELDER HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005908000 . This is a "AMERIHEALTH-TRADITIONAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001035 . This is a "HORIZON - SUB" identifier . This identifiers is of the category "OTHER".
  • Identifier: 315050 . This is a "HORIZON - SNF" identifier . This identifiers is of the category "OTHER".
  • Identifier: 301631 . This is a "US FAMILY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 542119 . This is a "AETNA-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005908000 . This is a "IBC-MANAGED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03040 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4465806 . This is a "UNYSIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005908000 . This is a "AMERIHEALTH-MANAGED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005908000 . This is a "IBC-TRADITIONAL" identifier . This identifiers is of the category "OTHER".




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