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Organization

499 PINE BROOK OPERATING, LLC

Active
Parent organization
499 PINE BROOK VENTURES, LLC
Other names
Lincoln Park Care Center
Organization subpart
Yes

Provider details

NPI number
Legal business name
499 PINE BROOK VENTURES, LLC
Authorized official
CHARLES-EDOUARD GROS (MANAGING MEMBER)
(973) 696-3300
Entity
Organization

Contact information

Practice address
499 PINE BROOK RD, LINCOLN PARK, NJ 07035-1804
(973) 696-3300
Mailing address
499 PINE BROOK RD, LINCOLN PARK, NJ 07035-1804
(973) 696-3300

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
061409
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00310412
NY
01
02621447
MEDICAID- NY SPECIAL PROVIDER ID
NY
05
4491203
NJ
Enumeration date
12/26/2012
Last updated
12/26/2012
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