Provider Demographics
NPI:1467740902
Name:THE LAKEWOOD OF VOORHEES OPERATOR
Entity Type:Organization
Organization Name:THE LAKEWOOD OF VOORHEES OPERATOR
Other - Org Name:THE VOORHEES CARE & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLFETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-635-1195
Mailing Address - Street 1:1302 LAUREL OAK RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4310
Mailing Address - Country:US
Mailing Address - Phone:856-346-1200
Mailing Address - Fax:856-346-0382
Practice Address - Street 1:1302 LAUREL OAK RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4310
Practice Address - Country:US
Practice Address - Phone:856-346-1200
Practice Address - Fax:856-346-0382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
NJ060408314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4469607Medicaid
NJ315187Medicare Oscar/Certification