Healthcare Provider Details

I. General information

NPI: 1740046184
Provider Name (Legal Business Name): WEST DEPTFORD SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 JESSUP RD
WEST DEPTFORD NJ
08066
US

IV. Provider business mailing address

550 JESSUP RD
WEST DEPTFORD NJ
08066
US

V. Phone/Fax

Practice location:
  • Phone: 856-848-9551
  • Fax:
Mailing address:
  • Phone: 856-848-9551
  • 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: PINCHOS BAK
Title or Position: PRESIDENT
Credential:
Phone: 908-783-3110