Healthcare Provider Details

I. General information

NPI: 1508448697
Provider Name (Legal Business Name): LCS BRIDGEWATER OPERATIONS II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 FRONTIER RD
BRIDGEWATER NJ
08807-2936
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 732-507-5151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: JASON VICTOR
Title or Position: SENIOR VP, TREASURER, MANAGER
Credential:
Phone: 515-875-4619