Provider Demographics
NPI:1720494313
Name:ALICE OPERATOR LLC
Entity Type:Organization
Organization Name:ALICE OPERATOR LLC
Other - Org Name:AUTUMN LAKE HEALTHCARE AT ALICE MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARYEH
Authorized Official - Middle Name:
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-358-6883
Mailing Address - Street 1:4260 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3351
Mailing Address - Country:US
Mailing Address - Phone:732-358-6883
Mailing Address - Fax:
Practice Address - Street 1:2095 ROCKROSE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1328
Practice Address - Country:US
Practice Address - Phone:410-889-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility