Basic Information
| Provider Information | |||||||||
| NPI: | 1376063651 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAUREL BROOK OPERATOR LLC | ||||||||
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| OtherOrganizationName: | LAUREL BROOK REHABILITATION AND HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 DUQUESNE BLVD | ||||||||
| Address2: | |||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087235073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329031958 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3718 CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080541104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562357100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2017 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | POSEN | ||||||||
| AuthorizedOfficialFirstName: | MINDEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICARE ADMINISTRATION OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7329031958 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | 07/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | NJ | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.