1639595390 NPI number — CARE HSL CARDINAL VILLAGE OPCO LLC

Table of content: (NPI 1639595390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639595390 NPI number — CARE HSL CARDINAL VILLAGE OPCO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE HSL CARDINAL VILLAGE OPCO 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:
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:
1639595390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
765 SKIPPACK PIKE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BLUE BELL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19422-1743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-793-4445
Provider Business Mailing Address Fax Number:
302-358-2978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 HURFFVILLE CROSSKEYS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEWELL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08080-2328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-582-5292
Provider Business Practice Location Address Fax Number:
856-582-5026
Provider Enumeration Date:
03/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BOBKA
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
GENERAL COUNSEL
Authorized Official Telephone Number:
215-793-4445

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  35A001 , 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)





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