Church Health Care, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

060311 Issued in NJ

Legal business name

CHURCH HEALTH CARE, LLC

Practice address

3718 Church Rd
Mount Laurel, NJ 08054-1104

Phone

(856) 235-7100

Fax

(856) 235-6813

NPI assigned

Aug 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Joseph F Mancuso

Title

Regional Financial Controller

Phone

(856) 912-8250

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Innova Health and Rehab at Mt. Laurel Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699885129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3718 CHURCH RD",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541104",
            "telephone_number": "856-235-7100",
            "fax_number": "856-235-6813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3718 CHURCH RD",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541104",
            "telephone_number": "856-235-7100",
            "fax_number": "856-235-6813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHURCH HEALTH CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MANCUSO",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "REGIONAL FINANCIAL CONTROLLER",
        "authorized_official_telephone_number": "856-912-8250",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": "060311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4465903",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innova Health and Rehab at Mt. Laurel",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Mount Laurel, NJ
• Providers in Mount Laurel, NJ by specialty
• Skilled Nursing Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.