MEDICARE: WEST SALEM OPERATIONS 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

General Provider Information

NPI Number	:	1639631104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST SALEM OPERATIONS LLC

Provider Business Mailing Address
First Line	:	23 SHENANDOAH DR
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4979
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 SHENANDOAH DR
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4979
Country	:	US
Telephone Number	:	619-565-3637
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ADAM KUSHNIR
Credential	:
Telephone Number	:	619-565-3637

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	04/03/2019

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Directions to “WEST SALEM OPERATIONS LLC ” Practice Location

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