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NPI Code Detail

MEDICARE: BEDROCK HCS AT WATERTOWN LLC

MEDICARE: BEDROCK HCS AT WATERTOWN 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 : 1972154011
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEDROCK HCS AT WATERTOWN LLC
Provider Business Mailing Address
First Line : WORKSPACE AT BITBEAN C/O ESTHER TILLIM
Second Line : 1776 AVE OF THE STATES SUITE 302
City : LAKEWOOD
State : NJ
Zip : 08701
Country : US
Telephone Number : 732-328-4977
Fax Number :
Provider Business Practice Location Address
First Line : 121 HOSPITAL DR
Second Line :
City : WATERTOWN
State : WI
Zip : 53098-3303
Country : US
Telephone Number : 920-261-9220
Fax Number :
Authorized Official
Title or Position : BOOKKEEPER
Name : ESTHER TILLIM
Credential :
Telephone Number : 732-328-7499
Provider Enumeration Date : 09/20/2019
Last Update Date : 09/20/2019

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