Healthcare Provider Details

I. General information

NPI: 1851990675
Provider Name (Legal Business Name): ELIZABETHTOWN OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 HEISEY AVENUE
ELIZABETHTOWN PA
17022-8107
US

IV. Provider business mailing address

28 ROOSEVELT AVENUE
LAKEWOOD NJ
08701-5654
US

V. Phone/Fax

Practice location:
  • Phone: 717-367-1831
  • Fax: 717-367-4439
Mailing address:
  • Phone: 732-744-4611
  • 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: MR. YECHIEL Y. HIRTH
Title or Position: MANAGER
Credential:
Phone: 732-744-4611