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Contact Information

11 HISTORY LANE OPERATING COMPANY, LLC
11 HISTORY LANE
JACKSON, NJ08527
 Phone: 732-367-6600
 Fax: 732-905-9641
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
 

Respite Care

385H00000X
Indicates primary specialty

NPI Profile & details for 11 HISTORY LANE OPERATING COMPANY, LLC

NPI Number 1932108693
LBN Legal business name 11 HISTORY LANE OPERATING COMPANY, LLC
Authorized official A. LUGO - (EXECUTIVE VP & GENERAL COUNSEL)
Entity Organization
Organization subpart 1 No
Enumeration date 07/15/2005
Last updated 08/13/2015 - About 11 years ago
Identifiers
NJ License # 0088447
NJ Medicaid 0059994
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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