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General NPI Number Information
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NPI Number | 1508235706
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Entity Type | Organization
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Legal Business Name | VINELAND OPERATING, LLC
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 1045 E CHESTNUT AVE
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City | VINELAND
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State | NJ
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Zip | 08360-5838
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Country | US
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Telephone | 718-360-8083
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Fax |
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Provider Business Mailing Address
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Address Line | 13742 71ST AVE
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City | FLUSHING
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State | NY
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Zip | 11367-1939
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CHARLES-EDOUARD GROS
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Credential |
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Telephone | 718-360-8083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 060601
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License Number State | NJ
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