Provider Demographics
NPI:1639595390
Name:CARE HSL CARDINAL VILLAGE OPCO LLC
Entity Type:Organization
Organization Name:CARE HSL CARDINAL VILLAGE OPCO LLC
Other - Org Name:CARDINAL VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BOBKA
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:215-793-4445
Mailing Address - Street 1:765 SKIPPACK PIKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1743
Mailing Address - Country:US
Mailing Address - Phone:215-793-4445
Mailing Address - Fax:302-358-2978
Practice Address - Street 1:455 HURFFVILLE CROSSKEYS RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2328
Practice Address - Country:US
Practice Address - Phone:856-582-5292
Practice Address - Fax:856-582-5026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE HSL OPCO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35A001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility