MEDICARE: 11 HISTORY LANE OPERATING COMPANY, 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	385H00000X	Respite Care	0088447	NJ
2	314000000X	Skilled Nursing Facility		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932108693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	11 HISTORY LANE OPERATING COMPANY, LLC

Provider Business Mailing Address
First Line	:	11 HISTORY LANE
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527
Country	:	US
Telephone Number	:	732-367-6600
Fax Number	:	732-905-9641

Provider Business Practice Location Address
First Line	:	11 HISTORY LANE
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527
Country	:	US
Telephone Number	:	732-367-6600
Fax Number	:	732-905-9641

Authorized Official
Title or Position	:	EXECUTIVE VP & GENERAL COUNSEL
Name	:	MR. A. ALBERTO LUGO
Credential	:
Telephone Number	:	201-242-4000

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	08/13/2015

Similar Medicare Providers

1518701655 — SPRING FORWARD ABA LLC
Practice Location Address:

12 BARNEGAT LN
JACKSON, NJ
08527-3229

Practice Phone: 804-992-9200
Practice Fax:

1447795224 — ESTHER TRESS OTR/L
Practice Location Address:

8 AMBASSADOR CT
JACKSON, NJ
08527-2883

Practice Phone: 347-512-4227
Practice Fax:

1336145176 — PAUL C HILEY MD
Practice Location Address:

2290 W COUNTY LINE RD
JACKSON, NJ
08527-2267

Practice Phone: 732-364-3881
Practice Fax: 732-364-4625

1467452722 — ROOPAL M. KARIA-PATEL MD
Practice Location Address:

27 S COOKS BRIDGE RD STE 2-20
JACKSON, NJ
08527-2463

Practice Phone: 732-987-5705
Practice Fax: 732-987-5706

1831190172 — DR. KWAMI DELALI AGBODZA MD
Practice Location Address:

15 WESTLAKE CT
JACKSON, NJ
08527-5160

Practice Phone: 732-961-6453
Practice Fax: 732-961-6453

1508852195 — DR. WILLIAM SYLVAN BARNES DPM
Practice Location Address:

2110 W COUNTY LINE RD , BLDG 2
JACKSON, NJ
08527-2049

Practice Phone: 732-367-6611
Practice Fax: 732-886-6702

Directions to “11 HISTORY LANE OPERATING COMPANY, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.