MEDICARE: WELLINGTON ESTATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1114447489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLINGTON ESTATES LLC

Provider Business Mailing Address
First Line	:	2018 STATE ROUTE 35
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-2558
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2018 STATE ROUTE 35
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-2558
Country	:	US
Telephone Number	:	732-282-1014
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	AVROHOM MAIEROVITS
Credential	:
Telephone Number	:	732-994-4324

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	06/27/2017

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