Healthcare Provider Details

I. General information

NPI: 1720476625
Provider Name (Legal Business Name): CV HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 OREGONIA RD
LEBANON OH
45036-1983
US

IV. Provider business mailing address

100 ROUTE 70 SUITE 3
LAKEWOOD NJ
08701-7406
US

V. Phone/Fax

Practice location:
  • Phone: 513-932-1121
  • Fax:
Mailing address:
  • Phone: 732-659-1353
  • Fax: 866-306-0259

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: JACOB S STERN
Title or Position: MANAGER
Credential:
Phone: 732-659-1353