Provider Demographics
NPI:1598711970
Name:92 BRICK ROAD OPERATING COMPANY LLC
Entity Type:Organization
Organization Name:92 BRICK ROAD OPERATING COMPANY LLC
Other - Org Name:MARLTON REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-591-5700
Mailing Address - Street 1:4550 LENA DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4922
Mailing Address - Country:US
Mailing Address - Phone:717-591-5709
Mailing Address - Fax:717-591-5710
Practice Address - Street 1:92 BRICK RD
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2177
Practice Address - Country:US
Practice Address - Phone:856-988-8778
Practice Address - Fax:856-988-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22252283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0001060000OtherAMERIHEALTH KEYSTONE
NJ313032OtherHORIZON BLUE CROSS
NJ313032OtherHORIZON NJ PLUS HMO
NJ313032OtherHORIZON TRADITIONAL PPO
NJ0001309Medicaid
NJ001060OtherAMERIHEALTH
NJ313032OtherFEDERAL BLUE CROSS
NJ7828294OtherAETNA GOLDEN MEDICARE
NJ313032OtherHORIZON MERCY
NJ313032OtherHORIZON NATIONAL
NJ313032OtherHORIZON CASUALTY
NJAETNA BLUE BELLOther2784259
NJ001060OtherAMERIHEALTH
NJ313032OtherHORIZON BLUE CROSS