Provider Demographics
NPI:1093300634
Name:SJV 1 CRESSKILL OPCO LLC
Entity Type:Organization
Organization Name:SJV 1 CRESSKILL OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-871-0300
Mailing Address - Street 1:3 TENAKILL PARK E
Mailing Address - Street 2:
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2051
Mailing Address - Country:US
Mailing Address - Phone:201-871-0300
Mailing Address - Fax:201-871-1331
Practice Address - Street 1:3 TENAKILL PARK E
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2051
Practice Address - Country:US
Practice Address - Phone:201-871-0300
Practice Address - Fax:201-871-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility