Healthcare Provider Details

I. General information

NPI: 1316624497
Provider Name (Legal Business Name): ADRIAN BAY OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAKESHIRE TRL
ADRIAN MI
49221-1565
US

IV. Provider business mailing address

1352 RIVER AVE UNIT B
LAKEWOOD NJ
08701-5646
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-0781
  • Fax:
Mailing address:
  • Phone: 718-807-1940
  • 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: MOSHE GOTTLIEB
Title or Position: MEMBER
Credential:
Phone: 732-370-8090