# 803 HACIENDA LANE OPERATIONS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bloomfield Nursing and Rehab
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134607690
- **Authorized official:** MICHAEL BERG (ASSISTANT SECRETARY)
- **Authorized official phone:** (610) 925-2254

## Contact information

- **Practice address:** 803 HACIENDA LN, BLOOMFIELD, NM 87413-5109
- **Practice address phone:** (610) 925-2254
- **Mailing address:** 101 E STATE ST, KENNETT SQUARE, PA 19348-3109
- **Mailing address phone:** (610) 925-2254

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NM | Yes |

## Other

- **Enumeration date:** 08/06/2018
- **Last updated:** 08/06/2018