Provider Demographics
NPI:1376660787
Name:LINWOOD
Entity Type:Organization
Organization Name:LINWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL RESIDENT ACCOUNTING MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRAMELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-813-2000
Mailing Address - Street 1:NEW ROAD & CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221
Mailing Address - Country:US
Mailing Address - Phone:856-813-2000
Mailing Address - Fax:856-813-2020
Practice Address - Street 1:525 FELLOWSHIP RD
Practice Address - Street 2:SUITE 360
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3415
Practice Address - Country:US
Practice Address - Phone:856-813-2000
Practice Address - Fax:856-813-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060104314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4462017Medicaid
NJ4462009Medicaid
NJ4462009Medicaid