Healthcare Provider Details

I. General information

NPI: 1639668890
Provider Name (Legal Business Name): LCS BRIDGEWATER OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MONROE ST
BRIDGEWATER NJ
08807-5002
US

IV. Provider business mailing address

400 LOCUST ST STE 820
DES MOINES IA
50309-2334
US

V. Phone/Fax

Practice location:
  • Phone: 908-595-6517
  • Fax: 908-595-6515
Mailing address:
  • Phone: 515-875-4500
  • Fax: 515-875-4781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. ALLISON D PENDROY
Title or Position: SVP AND MANAGER
Credential:
Phone: 515-875-4500