Provider Demographics
NPI:1972966422
Name:LAUREL SQUARE HEALTHCARE AND REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:LAUREL SQUARE HEALTHCARE AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-262-2255
Mailing Address - Street 1:260 CHAMBERS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-2809
Mailing Address - Country:US
Mailing Address - Phone:732-262-2255
Mailing Address - Fax:732-262-3332
Practice Address - Street 1:1020 OAK LANE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-3340
Practice Address - Country:US
Practice Address - Phone:732-262-2255
Practice Address - Fax:732-262-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA131302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395535Medicare Oscar/Certification