# 1165 EASTON AVENUE OPERATIONS LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SUMMIT CARE LLC
- **Other names:** Willow Creek Rehabilitation and Care Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1568839710
- **Legal business name:** SUMMIT CARE LLC
- **Authorized official:** MICHAEL T BERG (ASSISTANT SECRETARY)
- **Authorized official phone:** (505) 468-4742

## Contact information

- **Practice address:** 1165 EASTON AVE, SOMERSET, NJ 08873-1613
- **Practice address phone:** (732) 246-4100
- **Practice address fax:** (732) 246-4101
- **Mailing address:** 1165 EASTON AVE, SOMERSET, NJ 08873-1613
- **Mailing address phone:** (732) 246-4100
- **Mailing address fax:** (732) 246-4101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | — | — |
| 314000000X | Skilled Nursing Facility | — | NJ | Yes |

## Other

- **Enumeration date:** 08/24/2015
- **Last updated:** 04/12/2017