Healthcare Provider Details

I. General information

NPI: 1194526731
Provider Name (Legal Business Name): 11565 HARTS ROAD OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11565 HARTS RD
JACKSONVILLE FL
32218-3777
US

IV. Provider business mailing address

338 WHITESVILLE RD
JACKSON NJ
08527-5091
US

V. Phone/Fax

Practice location:
  • Phone: 732-719-5034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: AMITAI DAGAN
Title or Position: COO
Credential:
Phone: 732-719-5098