Provider Demographics
NPI:1689747685
Name:LBO ASSOCIATES LLC
Entity Type:Organization
Organization Name:LBO ASSOCIATES LLC
Other - Org Name:BELLE REVE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RABEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-409-9191
Mailing Address - Street 1:404 E HARFORD ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-1028
Mailing Address - Country:US
Mailing Address - Phone:570-409-9191
Mailing Address - Fax:570-409-9292
Practice Address - Street 1:404 E HARFORD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1028
Practice Address - Country:US
Practice Address - Phone:570-409-9191
Practice Address - Fax:570-409-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA60010200314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018870560001Medicaid
PA0018870560001Medicaid