Healthcare Provider Details

I. General information

NPI: 1386688141
Provider Name (Legal Business Name): ST CLOUD OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BROOK END DR
WEST ORANGE NJ
07052-1303
US

IV. Provider business mailing address

14C 53RD ST SUITE 220
BROOKLYN NY
11232-2644
US

V. Phone/Fax

Practice location:
  • Phone: 973-324-3000
  • Fax: 973-324-3005
Mailing address:
  • Phone: 718-567-0400
  • Fax: 718-567-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number306001
License Number StateNJ

VIII. Authorized Official

Name: MR. SAM STERN
Title or Position: COMPTROLLER
Credential:
Phone: 718-567-0400