Healthcare Provider Details

I. General information

NPI: 1811546955
Provider Name (Legal Business Name): CANTERBURY 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

1776 CAMBRIDGE DR
RICHMOND VA
23238-3203
US

IV. Provider business mailing address

1608 ROUTE 88
BRICK NJ
08724-3009
US

V. Phone/Fax

Practice location:
  • Phone: 804-740-6174
  • 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