Healthcare Provider Details

I. General information

NPI: 1417992942
Provider Name (Legal Business Name): STAFFORD CONVALESCENT CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 ROUTE 72 W
MANAHAWKIN NJ
08050-2417
US

IV. Provider business mailing address

101 E STATE ST
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 609-978-0600
  • Fax: 609-978-1635
Mailing address:
  • Phone: 610-925-4436
  • Fax: 610-925-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number080413
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0005682000
Identifier TypeOTHER
Identifier State
Identifier IssuerAMERIHEALTH
# 2
Identifier000849
Identifier TypeOTHER
Identifier State
Identifier IssuerHORIZION - SUB
# 3
Identifier15730
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 4
Identifier22-315441
Identifier TypeOTHER
Identifier State
Identifier IssuerHCPC
# 5
Identifier317427
Identifier TypeOTHER
Identifier State
Identifier IssuerUS FAMILY HEALTH CARE
# 6
Identifier315332
Identifier TypeOTHER
Identifier State
Identifier IssuerHORIZION - SNF
# 7
Identifier6231802
Identifier TypeOTHER
Identifier State
Identifier IssuerUNISYS #
# 8
Identifier2427479
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA-HMO

VIII. Authorized Official

Name: JANE DROPESKEY
Title or Position: CORPORATE MANAGER
Credential:
Phone: 610-925-4231