# BRISTOL GLEN INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588740401
- **Authorized official:** ROBERT PETERSON (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (732) 922-9800

## Contact information

- **Practice address:** 200 BRISTOL GLEN DR, NEWTON, NJ 07860-2329
- **Practice address phone:** (973) 300-5788
- **Practice address fax:** (973) 579-2357
- **Mailing address:** 205 JUMPING BROOK RD, NEPTUNE, NJ 07753-3197
- **Mailing address phone:** (732) 922-9800
- **Mailing address fax:** (732) 922-9804

## Taxonomy

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

## Other

- **Enumeration date:** 10/31/2006
- **Last updated:** 10/30/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4504003 | — | NJ |
| 05 | — | 9030204 | — | NJ |