Healthcare Provider Details

I. General information

NPI: 1730871765
Provider Name (Legal Business Name): MANCHESTER OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 SOLLEY DR
BALLWIN MO
63021-5248
US

IV. Provider business mailing address

311 BOULEVARD OF THE AMERICAS SUITE 201
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 636-391-0666
  • 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: JACQUES WOLF
Title or Position: MANAGER
Credential:
Phone: 908-430-5101