Provider Demographics
NPI:1336706340
Name:1621 ROUTE 22 WEST OPERATING COMPANY, LLC
Entity Type:Organization
Organization Name:1621 ROUTE 22 WEST OPERATING COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL/EXECUTIVE VICE PRES
Authorized Official - Prefix:
Authorized Official - First Name:ANDROVSKY
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:201-242-4006
Mailing Address - Street 1:1621 ROUTE 22 WEST
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805
Mailing Address - Country:US
Mailing Address - Phone:732-469-2000
Mailing Address - Fax:732-469-8917
Practice Address - Street 1:1621 ROUTE 22 WEST
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805
Practice Address - Country:US
Practice Address - Phone:732-469-2000
Practice Address - Fax:732-469-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility