Provider Demographics
NPI:1083360770
Name:STAFFORD OPCO, LLC
Entity Type:Organization
Organization Name:STAFFORD OPCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-619-9327
Mailing Address - Street 1:1275 ROUTE 72 W
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2473
Mailing Address - Country:US
Mailing Address - Phone:609-597-2500
Mailing Address - Fax:
Practice Address - Street 1:1275 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2473
Practice Address - Country:US
Practice Address - Phone:609-597-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ65A002OtherNJ LICENSE