Provider Demographics
NPI:1205600756
Name:MAPLE SHADE HEALTHCARE LLC
Entity type:Organization
Organization Name:MAPLE SHADE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ABE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-567-0402
Mailing Address - Street 1:630 HERMAN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3081
Mailing Address - Country:US
Mailing Address - Phone:877-567-0402
Mailing Address - Fax:
Practice Address - Street 1:794 N FORKLANDING RD
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-1049
Practice Address - Country:US
Practice Address - Phone:856-779-9333
Practice Address - Fax:856-779-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No385H00000XRespite Care FacilityRespite Care