Healthcare Provider Details

I. General information

NPI: 1780358473
Provider Name (Legal Business Name): CARRIAGE OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 GENE FIELD RD
SAINT JOSEPH MO
64506-1864
US

IV. Provider business mailing address

10 GRANDVIEW DR
LAKEWOOD NJ
08701-3881
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-1526
  • 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: 908-421-1184