Provider Demographics
NPI:1629575295
Name:JEFFERSONTOWN OPCO, LLC
Entity Type:Organization
Organization Name:JEFFERSONTOWN OPCO, LLC
Other - Org Name:JEFFERSONTOWN REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBSTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-497-1150
Mailing Address - Street 1:212 2ND ST STE 501
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3424
Mailing Address - Country:US
Mailing Address - Phone:732-497-1150
Mailing Address - Fax:
Practice Address - Street 1:3500 GOOD SAMARITAN WAY
Practice Address - Street 2:
Practice Address - City:JEFFERSONTOWN
Practice Address - State:KY
Practice Address - Zip Code:40299-6117
Practice Address - Country:US
Practice Address - Phone:502-267-7403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY314000000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care