Basic Information
| Provider Information | |||||||||
| NPI: | 1356805790 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCARLET OAKS NURSING AND REHABILITATION CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 AMERICA AVE | ||||||||
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| City: | LAKEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087014584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087831675 | ||||||||
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| Practice Location | |||||||||
| Address1: | 440 LAFAYETTE AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452201022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138610400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2019 | ||||||||
| LastUpdateDate: | 01/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | STERN | ||||||||
| AuthorizedOfficialFirstName: | JACOB | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7326591353 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SCARLET OAKS NURSING AND REHABILITATION CENTER LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 0167065 | 05 | OH | MEDICAID |