Healthcare Provider Details

I. General information

NPI: 1114495728
Provider Name (Legal Business Name): COLLINGSWOOD OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 HURLEY AVE
ROCKVILLE MD
20850-3118
US

IV. Provider business mailing address

635 DUQUESNE BLVD
BRICK NJ
08723-5073
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-8900
  • Fax:
Mailing address:
  • Phone: 732-903-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MINDEE POSEN
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 732-903-1958