MEDICARE: CORAL HARBOR OPERATOR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	061317	NJ

General Provider Information

NPI Number	:	1093180572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAL HARBOR OPERATOR LLC

Provider Business Mailing Address
First Line	:	2050 6TH AVE
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-6124
Country	:	US
Telephone Number	:	732-774-8300
Fax Number	:	732-774-0908

Provider Business Practice Location Address
First Line	:	2050 6TH AVE
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-6124
Country	:	US
Telephone Number	:	732-774-8300
Fax Number	:	732-276-9659

Authorized Official
Title or Position	:	MEDICARE ADMINISTRATION OFFICER
Name	:	MRS. MINDEE POSEN
Credential	:
Telephone Number	:	732-903-1958

Provider Enumeration Date	:	12/09/2015
Last Update Date	:	04/04/2024

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