Provider Demographics
NPI:1114583390
Name:GHC RB OPERATOR LLC
Entity Type:Organization
Organization Name:GHC RB OPERATOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VASYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-292-4363
Mailing Address - Street 1:1904 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1006
Mailing Address - Country:US
Mailing Address - Phone:732-292-4363
Mailing Address - Fax:
Practice Address - Street 1:325 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2104
Practice Address - Country:US
Practice Address - Phone:732-292-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty