# SR-73 AND LAKESIDE AVENUE OPERATIONS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PowerBack Rehabilitation, 113 South Route 73
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063763464
- **Authorized official:** JANE DROPESKEY (CORPORATE MANAGER)
- **Authorized official phone:** (610) 925-4231

## Contact information

- **Practice address:** 113 ROUTE 73, VOORHEES, NJ 08043-9573
- **Practice address phone:** (610) 925-2009
- **Practice address fax:** (610) 347-4098
- **Mailing address:** 101 E STATE ST, KENNETT SQUARE, PA 19348-3109
- **Mailing address phone:** (610) 925-2009
- **Mailing address fax:** (610) 347-4098

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 09/25/2012
- **Last updated:** 03/19/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 31-5513 | MEDICARE PTAN | NJ |