Provider Demographics
NPI:1295199537
Name:NOVACARE
Entity Type:Organization
Organization Name:NOVACARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-467-3421
Mailing Address - Street 1:520 BECKETT RD
Mailing Address - Street 2:
Mailing Address - City:LOGAN TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 BECKETT RD
Practice Address - Street 2:
Practice Address - City:LOGAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1732
Practice Address - Country:US
Practice Address - Phone:856-467-3421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SELECT MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01660100261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy