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NPI Code Detail

MEDICARE: 24 CREE DRIVE OPCO LLC

MEDICARE: 24 CREE DRIVE OPCO 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1215764683
Entity Type Code : Organization
Provider Name (Legal Business Name) : 24 CREE DRIVE OPCO LLC
Provider Business Mailing Address
First Line : 1105 E COUNTY LINE RD STE 201
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-2178
Country : US
Telephone Number : 732-707-9013
Fax Number :
Provider Business Practice Location Address
First Line : 24 CREE DR
Second Line :
City : LOCK HAVEN
State : PA
Zip : 17745-2639
Country : US
Telephone Number : 732-707-9013
Fax Number :
Authorized Official
Title or Position : SUPERIVSOR
Name : BLIMI AVIV
Credential :
Telephone Number : 973-285-2893
Provider Enumeration Date : 09/18/2024
Last Update Date : 09/18/2024

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Directions to “24 CREE DRIVE OPCO LLC ” Practice Location

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