Provider Demographics
NPI:1760750053
Name:MIDDLESEX COUNTY IMPROVEMENT AUTHORITY
Entity Type:Organization
Organization Name:MIDDLESEX COUNTY IMPROVEMENT AUTHORITY
Other - Org Name:ROOSEVELT CARE CENTER AT OLD BRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LIOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BENISTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-360-9830
Mailing Address - Street 1:1133 MARLBORO RD
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-4032
Mailing Address - Country:US
Mailing Address - Phone:732-360-9830
Mailing Address - Fax:732-360-9831
Practice Address - Street 1:1133 MARLBORO RD
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-4032
Practice Address - Country:US
Practice Address - Phone:732-360-9830
Practice Address - Fax:732-452-1950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDDLESEX COUNTY IMPROVEMENT AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-01
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12023314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0286176Medicaid
NJ0300390Medicaid
NJ0286176Medicaid