MEDICARE: ABBEY WOODS OPERATIONS 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1407412547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABBEY WOODS OPERATIONS LLC

Provider Business Mailing Address
First Line	:	1776 AVENUE OF THE STATES STE 103
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4592
Country	:	US
Telephone Number	:	516-727-1634
Fax Number	:

Provider Business Practice Location Address
First Line	:	5026 FARAON ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3375
Country	:	US
Telephone Number	:	816-279-1591
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	SAMUEL GOLDNER
Credential	:
Telephone Number	:	516-727-1634

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	09/16/2022

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