Provider Demographics
NPI:1770540171
Name:FORKIDCARE LLC
Entity type:Organization
Organization Name:FORKIDCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIZZICHILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:856-346-3300
Mailing Address - Street 1:1304 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:856-346-3300
Mailing Address - Fax:
Practice Address - Street 1:1304 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:856-346-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0604163140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4470001Medicaid
NJ4470001Medicaid