Healthcare Provider Details

I. General information

NPI: 1598127276
Provider Name (Legal Business Name): RICH SQUARE OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N MAIN ST
RICH SQUARE NC
27869-9577
US

IV. Provider business mailing address

410 MONMOUTH AVE STE201
LAKEWOOD NJ
08701-3711
US

V. Phone/Fax

Practice location:
  • Phone: 252-539-4161
  • 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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier345356
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICARE ID

VIII. Authorized Official

Name: HENRY STEINMETZ
Title or Position: MANAGER
Credential:
Phone: 732-813-5000