Organization · NPI-2

1165 Easton Avenue Operations LLC

Nursing Facility/Intermediate Care Facility · Somerset, NJ

NPI number1528577293

StatusActive

Last updated in NPPESJul 21, 2022

Details

NPI: 1528577293
Entity type: Organization (NPI-2)
Legal business name: 1165 Easton Avenue Operations LLC
Organization subpart: No
Enumeration date: Sep 26, 2017
Last updated: Jul 21, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
313M00000X	Nursing Facility/Intermediate Care Facility	00000	NJ	Yes

Other names

Willow Creek Rehabilitation Care Center (Doing Business As)

Practice location

1165 Easton Ave
Somerset, NJ 08873-1613

Phone 732-246-4100

Mailing address

1165 Easton Ave
Somerset, NJ 08873-1613

Phone 732-246-4100

Authorized official

Michael T Berg
Vp Gen Counsel Asst Secy
5054684742

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