Provider Demographics
NPI:1396708467
Name:RICHBORO SNF LLC
Entity type:Organization
Organization Name:RICHBORO SNF LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:YOSSI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-942-1344
Mailing Address - Street 1:4597 ROUTE 9 N
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3382
Mailing Address - Country:US
Mailing Address - Phone:866-942-1344
Mailing Address - Fax:215-357-6968
Practice Address - Street 1:253 TWINING FORD RD
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1843
Practice Address - Country:US
Practice Address - Phone:215-357-2032
Practice Address - Fax:215-357-6968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005752000OtherKEYSTONE 65
57586OtherAETNA US HEALTHCARE
0005752000OtherBLUE CROSS
17270OtherHEALTH PARTNERS
PA0011293400001Medicaid
0112934001OtherAMERICHOICE
1045041OtherKEYSTONE MERCY HEALTHPLAN
0112934001OtherAMERICHOICE