MEDICARE: ST. JAMES OPERATING 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	:	1669739207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JAMES OPERATING LLC

Provider Business Mailing Address
First Line	:	105 RIVER AVE
Second Line	:	SUITE 202
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-4202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 MORICHES RD
Second Line	:
City	:	SAINT JAMES
State	:	NY
Zip	:	11780-2150
Country	:	US
Telephone Number	:	631-862-8000
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	YOSSIE ZUCKER
Credential	:
Telephone Number	:	732-370-8090

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	04/20/2012

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