Healthcare Provider Details

I. General information

NPI: 1629060629
Provider Name (Legal Business Name): 229 BATH AVENUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 BATH AVE
LONG BRANCH NJ
07740-6102
US

IV. Provider business mailing address

104 PENSION RD
ENGLISHTOWN NJ
07726-8400
US

V. Phone/Fax

Practice location:
  • Phone: 732-229-4300
  • Fax: 732-571-0165
Mailing address:
  • Phone: 732-446-1804
  • Fax: 732-446-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061318
License Number StateNJ

VIII. Authorized Official

Name: MRS. BETH GOLDMAN
Title or Position: CONTROLLER
Credential:
Phone: 732-446-1804