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NPI Code Detail

MEDICARE: PROVIDENCE OPERATOR LLC

MEDICARE: PROVIDENCE OPERATOR LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1043722960
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE OPERATOR LLC
Provider Business Mailing Address
First Line : PO BOX 1030
Second Line :
City : BRICK
State : NJ
Zip : 08723-0090
Country : US
Telephone Number : 732-903-1958
Fax Number :
Provider Business Practice Location Address
First Line : 600 S WYCOMBE AVE
Second Line :
City : LANSDOWNE
State : PA
Zip : 19050-2835
Country : US
Telephone Number : 610-626-8065
Fax Number :
Authorized Official
Title or Position : CONTROLLER
Name : MINDEE DRILLMAN
Credential : CPA
Telephone Number : 732-903-1958
Provider Enumeration Date : 11/01/2017
Last Update Date : 04/03/2024

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Directions to “PROVIDENCE OPERATOR LLC ” Practice Location

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