Provider Demographics
NPI:1235819863
Name:LCB BASKING RIDGE, LLC
Entity Type:Organization
Organization Name:LCB BASKING RIDGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-619-9327
Mailing Address - Street 1:315 NORWOOD PARK S STE 205
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4681
Mailing Address - Country:US
Mailing Address - Phone:781-619-9320
Mailing Address - Fax:
Practice Address - Street 1:219 MOUNT AIRY RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2337
Practice Address - Country:US
Practice Address - Phone:908-495-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility