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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