Basic Information
| Provider Information | |||||||||
| NPI: | 1619504040 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEDAR HAVEN OPERATIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 DUTCH LANE RD | ||||||||
| Address2: | |||||||||
| City: | FREEHOLD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077285500 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 S 5TH AVE | ||||||||
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| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170429195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172740421 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2020 | ||||||||
| LastUpdateDate: | 03/25/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRECHER | ||||||||
| AuthorizedOfficialFirstName: | CHAIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7324317420 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.