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General NPI Number Information
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NPI Number | 1467198788
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Entity Type | Organization
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Legal Business Name | 11974 EDGEHILL TERRACE OPCO LLC
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 11974 EDGEHILL TERRACE RD
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City | PRINCESS ANNE
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State | MD
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Zip | 21853-2105
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Country | US
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Telephone | 410-651-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 28 ROOSEVELT AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5654
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Country | US
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Telephone | 732-744-4611
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | YECHIEL HIRTH
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Credential |
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Telephone | 732-744-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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