Healthcare Provider Details

I. General information

NPI: 1790449163
Provider Name (Legal Business Name): COURTLAND OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23020 MAIN ST
COURTLAND VA
23837-1133
US

IV. Provider business mailing address

311 BLVD OF THE AMERICAS STE 504
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 757-653-0908
  • Fax:
Mailing address:
  • Phone:
  • 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: TZVI ALTER
Title or Position: CEO
Credential:
Phone: 732-719-7270