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General NPI Number Information
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NPI Number | 1841089802
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Entity Type | Organization
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Legal Business Name | INDIAN ROCK AL LLC
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 265 DAVE CREEK PKWY
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City | FAIRFIELD BAY
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State | AR
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Zip | 72088-3106
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Country | US
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Telephone | 501-884-3210
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Fax | 501-884-6800
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Provider Business Mailing Address
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Address Line | 362 E KENNEDY BLVD
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City | LAKEWOOD
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State | NJ
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Zip | 08701-1434
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Country | US
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Telephone | 718-838-1500
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CHAIM HERZBERG
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Credential |
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Telephone | 718-838-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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