Basic Information
| Provider Information | |||||||||
| NPI: | 1043256514 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MERIDIAN HEALTHCARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VOORHEES CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193483109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109254436 | ||||||||
| FaxNumber: | 6109254351 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 E EVESHAM RD | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080439547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567511600 | ||||||||
| FaxNumber: | 8567511548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | DROPESKEY | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CORPORATE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6109254231 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 060414 | NJ | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0005670000 | 01 | AMERIHEALTH | OTHER | 126 | 01 | ELDER HEALTH | OTHER | 212042 | 01 | US FAMILY HEALTH PLAN | OTHER | 0005670000 | 01 | IBC | OTHER | 04160 | 05 | NJ | MEDICAID | 315219 | 01 | HORIZION - SNF | OTHER | 4469909 | 01 | UNISYS # | OTHER | 526133 | 01 | AETNA-HMO | OTHER | 000853 | 01 | HORIZION - NJ | OTHER | IY0240 | 01 | HEALTHNET OF PA | OTHER |