# 11 HISTORY LANE OPERATING COMPANY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Care One at Jackson
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932108693
- **Authorized official:** MR. A. ALBERTO LUGO (EXECUTIVE VP & GENERAL COUNSEL)
- **Authorized official phone:** (201) 242-4000

## Contact information

- **Practice address:** 11 HISTORY LANE, JACKSON, NJ 08527
- **Practice address phone:** (732) 367-6600
- **Practice address fax:** (732) 905-9641
- **Mailing address:** 11 HISTORY LANE, JACKSON, NJ 08527
- **Mailing address phone:** (732) 367-6600
- **Mailing address fax:** (732) 905-9641

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NJ | Yes |
| 385H00000X | Respite Care | 0088447 | NJ | — |

## Other

- **Enumeration date:** 07/15/2005
- **Last updated:** 08/13/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0059994 | — | NJ |