Provider Demographics
NPI:1114641776
Name:2050 TREVERTON ROAD OPCO
Entity Type:Organization
Organization Name:2050 TREVERTON ROAD OPCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF AR
Authorized Official - Prefix:
Authorized Official - First Name:BLIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AVIV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-285-2893
Mailing Address - Street 1:1105 E COUNTY LINE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2050 TREVORTON RD
Practice Address - Street 2:
Practice Address - City:COAL TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:17866-9405
Practice Address - Country:US
Practice Address - Phone:570-644-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility