MEDICARE: LAUREL SQUARE HEALTHCARE AND REHABILITATION 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	131302	PA

General Provider Information

NPI Number	:	1972966422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREL SQUARE HEALTHCARE AND REHABILITATION CENTER LLC

Provider Business Mailing Address
First Line	:	260 CHAMBERS BRIDGE RD
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-2809
Country	:	US
Telephone Number	:	732-262-2255
Fax Number	:	732-262-3332

Provider Business Practice Location Address
First Line	:	1020 OAK LANE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-3340
Country	:	US
Telephone Number	:	732-262-2255
Fax Number	:	732-262-3332

Authorized Official
Title or Position	:	CONTROLLER
Name	:	BEN FRIEDMAN
Credential	:
Telephone Number	:	732-262-2255

Provider Enumeration Date	:	04/01/2016
Last Update Date	:	04/01/2016

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