Provider Demographics
NPI:1215576186
Name:HEARTWOOD OPERATOR LLC
Entity Type:Organization
Organization Name:HEARTWOOD OPERATOR LLC
Other - Org Name:HEARTWOOD EXTENDED HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:YENOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-693-4239
Mailing Address - Street 1:456 CHESTNUT ST UNIT 303
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-6124
Mailing Address - Country:US
Mailing Address - Phone:347-693-4239
Mailing Address - Fax:
Practice Address - Street 1:1649 E 72ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-5402
Practice Address - Country:US
Practice Address - Phone:253-472-9027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-24
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility