Organization
STAFFORD OPCO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEO S JACQUES (CONTROLLER)
(781) 619-9327
Entity
Organization
Contact information
Practice address
1275 ROUTE 72 W, MANAHAWKIN, NJ 08050-2473
(609) 597-2500
Mailing address
1275 ROUTE 72 W, MANAHAWKIN, NJ 08050-2473
(609) 597-2500
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
65A002
NJ LICENSE
NJ
Enumeration date
02/22/2022
Last updated
02/22/2022
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