Provider Demographics
NPI:1295201226
Name:3000 HILLTOP ROAD OPERATIONS LLC
Entity Type:Organization
Organization Name:3000 HILLTOP ROAD OPERATIONS LLC
Other - Org Name:WHITING HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4742
Mailing Address - Street 1:3000 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-1349
Mailing Address - Country:US
Mailing Address - Phone:732-849-4400
Mailing Address - Fax:732-849-4401
Practice Address - Street 1:3000 HILLTOP RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-1349
Practice Address - Country:US
Practice Address - Phone:732-849-4400
Practice Address - Fax:732-849-4401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0540145Medicaid