Healthcare Provider Details

I. General information

NPI: 1548494222
Provider Name (Legal Business Name): TUCKER HOUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WALLACE ST
PHILADELPHIA PA
19123-2502
US

IV. Provider business mailing address

51 CRAGWOOD RD SUITE 101
SOUTH PLAINFIELD NJ
07080-2405
US

V. Phone/Fax

Practice location:
  • Phone: 215-235-1600
  • Fax:
Mailing address:
  • Phone: 908-315-3410
  • Fax: 908-292-1020

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: HESHY KLEIN
Title or Position: MEMBER
Credential:
Phone: 908-315-3410