Healthcare Provider Details

I. General information

NPI: 1740289040
Provider Name (Legal Business Name): LAKEWOOD OF VOORHEES ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 LAUREL OAK RD
VOORHEES NJ
08043-4310
US

IV. Provider business mailing address

1302 LAUREL OAK RD
VOORHEES NJ
08043-4310
US

V. Phone/Fax

Practice location:
  • Phone: 856-346-1200
  • Fax: 856-665-5708
Mailing address:
  • Phone: 856-346-1200
  • Fax: 856-665-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060408
License Number StateNJ

VIII. Authorized Official

Name: MR. LENARD BROWN
Title or Position: C.F.O.
Credential:
Phone: 856-663-4044