Provider Demographics
NPI:1043722960
Name:PROVIDENCE OPERATOR LLC
Entity Type:Organization
Organization Name:PROVIDENCE OPERATOR LLC
Other - Org Name:PROVIDENCE REHABILITATION AND HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MINDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:732-903-1958
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-0090
Mailing Address - Country:US
Mailing Address - Phone:732-903-1958
Mailing Address - Fax:
Practice Address - Street 1:600 S WYCOMBE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2835
Practice Address - Country:US
Practice Address - Phone:610-626-8065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility