Basic Information
| Provider Information | |||||||||
| NPI: | 1831667443 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POTOMAC VALLEY OPERATOR LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 DUQUESNE BLVD | ||||||||
| Address2: | |||||||||
| City: | BRICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087235073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329031958 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1235 POTOMAC VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208502757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017620700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2018 | ||||||||
| LastUpdateDate: | 11/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | ROKOWSKY | ||||||||
| AuthorizedOfficialFirstName: | YITZCHOK | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7329031958 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.