MEDICARE: IVY HILL REHAB CENTER 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
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1609319797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVY HILL REHAB CENTER LLC

Provider Business Mailing Address
First Line	:	245 BIRCHWOOD AVE
Second Line	:
City	:	CRANFORD
State	:	NJ
Zip	:	07016-2510
Country	:	US
Telephone Number	:	908-315-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 IVY HILL ROAD
Second Line	:
City	:	WYNDMOOR
State	:	PA
Zip	:	19150
Country	:	US
Telephone Number	:	215-233-1314
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MS. TERRI R SHERMAN
Credential	:
Telephone Number	:	908-315-3400

Provider Enumeration Date	:	11/22/2016
Last Update Date	:	11/22/2016

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