Healthcare Provider Details

I. General information

NPI: 1740705805
Provider Name (Legal Business Name): ETOWN OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 HEISEY AVE
ELIZABETHTOWN PA
17022-8107
US

IV. Provider business mailing address

10 GRANDVIEW DR
LAKEWOOD NJ
08701-3881
US

V. Phone/Fax

Practice location:
  • Phone: 717-367-1831
  • Fax:
Mailing address:
  • Phone: 908-421-1184
  • Fax:

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: JACQUES WOLF
Title or Position: MANAGING MEMBER
Credential:
Phone: 908-621-1184