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General NPI Number Information
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NPI Number | 1598323099
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Entity Type | Organization
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Legal Business Name | SKILES AVENUE AND STERLING DRIVE URBAN RENEWAL OPERATIONS LLC
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 10 STERLING DR
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City | PISCATAWAY
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State | NJ
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Zip | 08854-4911
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Country | US
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Telephone | 732-917-2900
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Fax | 732-917-2901
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Provider Business Mailing Address
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Address Line | 10 STERLING DR
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City | PISCATAWAY
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State | NJ
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Zip | 08854-4911
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Country | US
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Telephone | 732-917-2900
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Fax | 732-917-2901
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MICHAEL THEODORE BERG
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Credential |
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Telephone | 505-468-4742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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