Organization
SR-73 AND LAKESIDE AVENUE OPERATIONS LLC
Active
Other names
PowerBack Rehabilitation, 113 South Route 73
Organization subpart
No
Provider details
NPI number
Authorized official
JANE DROPESKEY (CORPORATE MANAGER)
(610) 925-4231
Entity
Organization
Contact information
Practice address
113 ROUTE 73, VOORHEES, NJ 08043-9573
(610) 925-2009
(610) 347-4098
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-2009
(610) 347-4098
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31-5513
MEDICARE PTAN
NJ
Enumeration date
09/25/2012
Last updated
03/19/2013
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