Provider Demographics
NPI:1851990675
Name:ELIZABETHTOWN OPCO LLC
Entity Type:Organization
Organization Name:ELIZABETHTOWN OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:YECHIEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-744-4611
Mailing Address - Street 1:28 ROOSEVELT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5654
Mailing Address - Country:US
Mailing Address - Phone:732-744-4611
Mailing Address - Fax:
Practice Address - Street 1:141 HEISEY AVENUE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-8107
Practice Address - Country:US
Practice Address - Phone:717-367-1831
Practice Address - Fax:717-367-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility