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Organization
1165 EASTON AVENUE OPERATIONS LLC
Active
Organization
1165 EASTON AVENUE OPERATIONS LLC
Active
Other names
WILLOW CREEK REHABILITATION CARE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T BERG (VP GEN COUNSEL ASST SECY)
(505) 468-4742
Entity
Organization
Contact information
Practice address
1165 EASTON AVE, SOMERSET, NJ 08873-1613
(732) 246-4100
Mailing address
1165 EASTON AVE, SOMERSET, NJ 08873-1613
(732) 246-4100
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
00000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000
NON MEDICARE
NJ
Enumeration date
09/26/2017
Last updated
07/21/2022
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