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NPI Code Detail

MEDICARE: CLIVEDEN CENTER, LLC

MEDICARE: CLIVEDEN 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
1314000000XSkilled Nursing Facility330402PA

General Provider Information

NPI Number : 1881828705
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLIVEDEN CENTER, LLC
Provider Business Mailing Address
First Line : 51 CRAGWOOD RD
Second Line : SUITE 101
City : SOUTH PLAINFIELD
State : NJ
Zip : 07080-2405
Country : US
Telephone Number : 908-315-3410
Fax Number : 908-292-1020
Provider Business Practice Location Address
First Line : 6400 GREENE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19119-3231
Country : US
Telephone Number : 215-844-6400
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : HESHY KLEIN
Credential :
Telephone Number : 908-315-3410
Provider Enumeration Date : 05/06/2009
Last Update Date : 08/12/2009

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