Healthcare Provider Details

I. General information

NPI: 1093879165
Provider Name (Legal Business Name): RED BANK ACQUISITION 1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHAPIN AVE
RED BANK NJ
07701-1418
US

IV. Provider business mailing address

100 CHAPIN AVE
RED BANK NJ
07701-1418
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-8811
  • Fax: 732-783-0379
Mailing address:
  • Phone: 732-741-8811
  • Fax: 732-783-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061325
License Number StateNJ

VIII. Authorized Official

Name: MR. ZEV FARKAS
Title or Position: CEO
Credential: LNHA
Phone: 732-741-8811