Healthcare Provider Details

I. General information

NPI: 1720494313
Provider Name (Legal Business Name): ALICE OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 ROCKROSE AVE
BALTIMORE MD
21211-1328
US

IV. Provider business mailing address

4260 ROUTE 9
HOWELL NJ
07731-3351
US

V. Phone/Fax

Practice location:
  • Phone: 410-889-9700
  • Fax:
Mailing address:
  • Phone: 732-358-6883
  • 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: MR. ARYEH STERN
Title or Position: MEMBER
Credential:
Phone: 732-358-6883