Healthcare Provider Details

I. General information

NPI: 1811843543
Provider Name (Legal Business Name): 12-15 SADDLE RIVER ROAD OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12-15 SADDLE RIVER RD
FAIR LAWN NJ
07410-5808
US

IV. Provider business mailing address

9526 W PICO BLVD
LOS ANGELES CA
90035-1202
US

V. Phone/Fax

Practice location:
  • Phone: 323-928-9445
  • Fax:
Mailing address:
  • Phone: 323-928-9445
  • 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: AVROHOM T
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 323-928-9445