Provider Demographics
NPI:1033700380
Name:WELL BL PORTFOLIO 1 OPCO LLC
Entity Type:Organization
Organization Name:WELL BL PORTFOLIO 1 OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-813-2000
Mailing Address - Street 1:41 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4038
Mailing Address - Country:US
Mailing Address - Phone:908-522-8852
Mailing Address - Fax:
Practice Address - Street 1:41 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-4038
Practice Address - Country:US
Practice Address - Phone:908-522-8852
Practice Address - Fax:908-522-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility