Provider Demographics
NPI:1699885129
Name:CHURCH HEALTH CARE, LLC
Entity type:Organization
Organization Name:CHURCH HEALTH CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL FINANCIAL CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:MANCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-912-8250
Mailing Address - Street 1:3718 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1104
Mailing Address - Country:US
Mailing Address - Phone:856-235-7100
Mailing Address - Fax:856-235-6813
Practice Address - Street 1:3718 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1104
Practice Address - Country:US
Practice Address - Phone:856-235-7100
Practice Address - Fax:856-235-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060311314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4465903Medicaid
NJ315032Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER