Healthcare Provider Details

I. General information

NPI: 1225492705
Provider Name (Legal Business Name): 2020 ROUTE 23 OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 01/09/2025
Certification Date: 12/27/2024
Deactivation Date: 12/31/2024
Reactivation Date: 01/09/2025

III. Provider practice location address

2020 ROUTE 23
WAYNE NJ
07470-6521
US

IV. Provider business mailing address

C/O SPRING HILLS LLC 26 MAIN STREET
EDISON NJ
08837
US

V. Phone/Fax

Practice location:
  • Phone: 973-305-8400
  • Fax:
Mailing address:
  • Phone: 973-305-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061629
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier512346
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: GREG B. HOOK
Title or Position: EVP COMPLIANCE
Credential:
Phone: 201-953-0546