Basic Information
| Provider Information | |||||||||
| NPI: | 1639668890 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LCS BRIDGEWATER OPERATIONS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ARBOR AT LAUREL CIRCLE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 LOCUST ST STE 820 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503092334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5158754500 | ||||||||
| FaxNumber: | 5158754781 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | BRIDGEWATER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088075002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085956517 | ||||||||
| FaxNumber: | 9085956515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2018 | ||||||||
| LastUpdateDate: | 05/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | PENDROY | ||||||||
| AuthorizedOfficialFirstName: | ALLISON | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP AND MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5158754500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 251J00000X | Y | Agencies | Nursing Care |
No ID Information.