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General NPI Number Information
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NPI Number | 1790565554
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Entity Type | Organization
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Legal Business Name | 4401 HAVERFORD AVENUE OPCO LLC
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 4401 HAVERFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-1332
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Country | US
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Telephone | 732-592-2205
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 E COUNTY LINE RD STE 201
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City | LAKEWOOD
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State | NJ
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Zip | 08701-2178
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Country | US
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Telephone | 732-592-2205
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BENJAMIN KURLAND
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Credential |
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Telephone | 732-592-2205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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