Provider Demographics
NPI:1518955970
Name:OAK PARK, LLC
Entity Type:Organization
Organization Name:OAK PARK, LLC
Other - Org Name:ARISTACARE AT ALAMEDA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:HESHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-315-3400
Mailing Address - Street 1:51 CRAGWOOD RD
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2405
Mailing Address - Country:US
Mailing Address - Phone:908-315-3400
Mailing Address - Fax:908-226-5177
Practice Address - Street 1:303 ELM ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4015
Practice Address - Country:US
Practice Address - Phone:732-442-9540
Practice Address - Fax:732-442-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061209314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00317973Medicaid
NJ4484606Medicaid
NJ315180Medicare ID - Type Unspecified
NY00317973Medicaid