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Organization
11 HISTORY LANE OPERATING COMPANY, LLC
Active
Organization
11 HISTORY LANE OPERATING COMPANY, LLC
Active
Other names
Care One at Jackson
Organization subpart
No
Provider details
NPI number
Authorized official
MR. A. ALBERTO LUGO (EXECUTIVE VP & GENERAL COUNSEL)
(201) 242-4000
Entity
Organization
Contact information
Practice address
11 HISTORY LANE, JACKSON, NJ 08527
(732) 367-6600
(732) 905-9641
Mailing address
11 HISTORY LANE, JACKSON, NJ 08527
(732) 367-6600
(732) 905-9641
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
NJ
385H00000X
Respite Care
0088447
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0059994
—
NJ
Enumeration date
07/15/2005
Last updated
08/13/2015
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