Healthcare Provider Details

I. General information

NPI: 1174172217
Provider Name (Legal Business Name): WOODBINE OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2729 KING ST
ALEXANDRIA VA
22302-4008
US

IV. Provider business mailing address

1608 ROUTE 88
BRICK NJ
08724-3009
US

V. Phone/Fax

Practice location:
  • Phone: 703-836-8838
  • Fax:
Mailing address:
  • Phone: 732-903-1958
  • 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: YITZCHOK ROKOWSKY
Title or Position: PRINCIPLE
Credential:
Phone: 732-903-1958