Innova Burlington Church Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

INNOVA BURLINGTON CHURCH OPERATIONS LLC

Doing business as

Mount Laurel Center for Rehabilitation & Healthcare

Practice address

3718 Church Rd
Mount Laurel, NJ 08054-1104

Phone

(856) 235-7100

NPI assigned

Dec 13, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Daryl Hagler

Title

Member

Phone

(718) 931-9700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mount Laurel Center for Rehabilitation & Healthcare Doing business as

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

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487721600000",
    "number": "1851669287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4770 WHITE PLAINS RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104701104",
            "telephone_number": "718-931-9700"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVA BURLINGTON CHURCH OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-13",
        "last_updated": "2017-02-22",
        "status": "A",
        "authorized_official_last_name": "HAGLER",
        "authorized_official_first_name": "DARYL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "718-931-9700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04465903",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Laurel Center for Rehabilitation & Healthcare",
            "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 Feb 22, 2017; 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.