Provider Demographics
NPI:1215764683
Name:24 CREE DRIVE OPCO LLC
Entity type:Organization
Organization Name:24 CREE DRIVE OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERIVSOR
Authorized Official - Prefix:
Authorized Official - First Name:BLIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AVIV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-285-2893
Mailing Address - Street 1:1105 E COUNTY LINE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2178
Mailing Address - Country:US
Mailing Address - Phone:732-707-9013
Mailing Address - Fax:
Practice Address - Street 1:24 CREE DR
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-2639
Practice Address - Country:US
Practice Address - Phone:732-707-9013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility