Provider Demographics
NPI:1831667443
Name:POTOMAC VALLEY OPERATOR LLC
Entity Type:Organization
Organization Name:POTOMAC VALLEY OPERATOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-903-1958
Mailing Address - Street 1:635 DUQUESNE BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-5073
Mailing Address - Country:US
Mailing Address - Phone:732-903-1958
Mailing Address - Fax:
Practice Address - Street 1:1235 POTOMAC VALLEY RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2757
Practice Address - Country:US
Practice Address - Phone:301-762-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility