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Organization
3809 BAYSHORE ROAD OPERATIONS LLC
Active
Organization
3809 BAYSHORE ROAD OPERATIONS LLC
Active
Parent organization
GENESIS NJ HOLDINGS LLC
Other names
Victoria Manor
Organization subpart
Yes
Provider details
NPI number
Legal business name
GENESIS NJ HOLDINGS LLC
Authorized official
WALTER KIELER (PRESIDENT)
(505) 468-4742
Entity
Organization
Contact information
Practice address
3809 BAYSHORE RD, NORTH CAPE MAY, NJ 08204-3259
(609) 898-0677
(609) 898-1186
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-4436
(610) 925-4351
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
060508
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006179000
AMERIHEALTH
—
01
—
000852
HORIZON - SUB
—
01
—
0261173
MOLINA #
NJ
05
—
05400
—
NJ
01
—
315281
HORIZON - SNF
—
01
—
316929
US FAMILY HEALTH PLAN
—
01
—
4471709
UNISYS #
—
01
—
489813
AETNA-HMO
—
01
—
62-1518645
CONSUMER HEALTH NETWORK
—
Enumeration date
06/24/2006
Last updated
06/12/2015
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