Organization · NPI-2

1165 Easton Avenue Operations LLC

Skilled Nursing Facility · Somerset, NJ

NPI number1568839710

StatusActive

Last updated in NPPESApr 12, 2017

Details

NPI: 1568839710
Entity type: Organization (NPI-2)
Legal business name: 1165 Easton Avenue Operations LLC
Organization subpart: Yes
Enumeration date: Aug 24, 2015
Last updated: Apr 12, 2017

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
314000000X	Skilled Nursing Facility	–	NJ	Yes
313M00000X	Nursing Facility/Intermediate Care Facility	–	–

Other names

Willow Creek Rehabilitation And Care Center (Doing Business As)

Practice location

1165 Easton Ave
Somerset, NJ 08873-1613

Phone 732-246-4100 · Fax 732-246-4101

Mailing address

1165 Easton Ave
Somerset, NJ 08873-1613

Phone 732-246-4100 · Fax 732-246-4101

Authorized official

Michael T Berg
Assistant Secretary
5054684742

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