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General NPI Number Information
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NPI Number | 1598180028
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Entity Type | Organization
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Legal Business Name | VALLEY STREAM OPERATOR LLC
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 94 SUMMER ST
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City | FITCHBURG
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State | MA
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Zip | 01420-5761
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Country | US
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Telephone | 978-343-3530
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Fax | 732-608-2976
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Provider Business Mailing Address
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Address Line | PO BOX 1030
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City | BRICK
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State | NJ
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Zip | 08723-0090
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Country | US
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Telephone | 732-606-5973
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Fax | 732-608-2976
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. NACHUM ROKEACH
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Credential |
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Telephone | 732-232-9217
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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 |
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License Number State | MA
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