Healthcare Provider Details

I. General information

NPI: 1306656921
Provider Name (Legal Business Name): CP OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6212 WALNUT ST
PHILADELPHIA PA
19139-3706
US

IV. Provider business mailing address

6212 WALNUT ST
PHILADELPHIA PA
19139-3706
US

V. Phone/Fax

Practice location:
  • Phone: 215-476-6264
  • Fax:
Mailing address:
  • Phone:
  • 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: LESLIE KUSTER
Title or Position: MANAGER
Credential:
Phone: 917-434-4979