Provider Demographics
NPI:1104626332
Name:BRIDGETON SNF LLC
Entity type:Organization
Organization Name:BRIDGETON SNF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHLOMO
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-576-3754
Mailing Address - Street 1:14 TRUMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5662
Mailing Address - Country:US
Mailing Address - Phone:347-576-3754
Mailing Address - Fax:
Practice Address - Street 1:99 MANHEIM AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2114
Practice Address - Country:US
Practice Address - Phone:856-455-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility