Provider Demographics
NPI:1306969829
Name:KDG OPERATING COMPANY, LLC
Entity type:Organization
Organization Name:KDG OPERATING COMPANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:T
Authorized Official - Last Name:DIOGUARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-496-1505
Mailing Address - Street 1:KAPLAN DEVELOPMENT GROUP
Mailing Address - Street 2:100 JERICHO QUADRANGLE SUITE 142
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2408
Mailing Address - Country:US
Mailing Address - Phone:516-496-1505
Mailing Address - Fax:516-496-1509
Practice Address - Street 1:7999 N CRESCENT BLVD
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-1402
Practice Address - Country:US
Practice Address - Phone:856-488-5557
Practice Address - Fax:856-488-9523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ15C000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0104124Medicaid