Provider Demographics
NPI:1689050064
Name:1351 OLD FREEHOLD ROAD OPERATIONS LLC
Entity Type:Organization
Organization Name:1351 OLD FREEHOLD ROAD OPERATIONS LLC
Other - Org Name:BEY LEA VILLAGE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4742
Mailing Address - Street 1:1351 OLD FREEHOLD RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2775
Mailing Address - Country:US
Mailing Address - Phone:732-240-0090
Mailing Address - Fax:732-240-0091
Practice Address - Street 1:1351 OLD FREEHOLD RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2775
Practice Address - Country:US
Practice Address - Phone:732-240-0090
Practice Address - Fax:732-240-0091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS NJ HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-07
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility