Provider Demographics
NPI:1659982452
Name:CLINTON ALF OPERATIONS LLC
Entity Type:Organization
Organization Name:CLINTON ALF OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-993-9444
Mailing Address - Street 1:410 MONMOUTH AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3747
Mailing Address - Country:US
Mailing Address - Phone:732-400-8574
Mailing Address - Fax:
Practice Address - Street 1:91 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2139
Practice Address - Country:US
Practice Address - Phone:860-669-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility