Healthcare Provider Details

I. General information

NPI: 1104626332
Provider Name (Legal Business Name): BRIDGETON SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MANHEIM AVE
BRIDGETON NJ
08302-2114
US

IV. Provider business mailing address

14 TRUMAN AVE
LAKEWOOD NJ
08701-5662
US

V. Phone/Fax

Practice location:
  • Phone: 856-455-2100
  • Fax:
Mailing address:
  • Phone: 347-576-3754
  • 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: SHLOMO FOGEL
Title or Position: MANAGING MEMBER
Credential:
Phone: 347-576-3754