# 1165 EASTON AVENUE OPERATIONS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WILLOW CREEK REHABILITATION CARE CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528577293
- **Authorized official:** MICHAEL T BERG (VP GEN COUNSEL ASST SECY)
- **Authorized official phone:** (505) 468-4742

## Contact information

- **Practice address:** 1165 EASTON AVE, SOMERSET, NJ 08873-1613
- **Practice address phone:** (732) 246-4100
- **Mailing address:** 1165 EASTON AVE, SOMERSET, NJ 08873-1613
- **Mailing address phone:** (732) 246-4100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 00000 | NJ | Yes |

## Other

- **Enumeration date:** 09/26/2017
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00000 | NON MEDICARE | NJ |