Healthcare Provider Details

I. General information

NPI: 1750380010
Provider Name (Legal Business Name): BARNEGAT OPERATING CO., L.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 WYNNWOOD AVE
CHERRY HILL NJ
08002-3256
US

IV. Provider business mailing address

859 W BAY AVE
BARNEGAT NJ
08005-2127
US

V. Phone/Fax

Practice location:
  • Phone: 856-663-4044
  • Fax: 856-665-5708
Mailing address:
  • Phone: 609-698-1400
  • Fax: 856-665-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061524
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier4495004
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier0078107
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerRES-PROV

VIII. Authorized Official

Name: MR. LENARD BROWN
Title or Position: DIR. ACCOUNT RECEIVABLE
Credential:
Phone: 856-663-4044