Healthcare Provider Details

I. General information

NPI: 1487624649
Provider Name (Legal Business Name): ROWANSOM CARES INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 LAUREL RD E UDP, SUITE 1100
STRATFORD NJ
08084-1354
US

IV. Provider business mailing address

PO BOX 71356
PHILADELPHIA PA
19176-1356
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-7036
  • Fax: 856-566-6108
Mailing address:
  • Phone: 856-566-6706
  • Fax: 856-566-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KELI WORKMAN
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 856-566-6831