Provider Demographics
NPI:1831357136
Name:DEL BOCA VISTA, LP
Entity type:Organization
Organization Name:DEL BOCA VISTA, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER OF GEN. PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARDIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-543-6600
Mailing Address - Street 1:370 REED RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-4016
Mailing Address - Country:US
Mailing Address - Phone:610-543-6600
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35A001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility