11 History Lane Operating Company, LLC
NPI #1073170072 in Jackson, New Jersey
Provider Information
- NPI Number
- 1073170072
- Entity Type
- Organization
- Organization Name
- 11 History Lane Operating Company, LLC
- Primary Specialty
- Assisted Living Facility
- Enumeration Date
- May 24, 2019
- Last Updated
- May 24, 2019
Practice Location
- Address
- 11 HISTORY LANE
- City
- Jackson
- State
- New Jersey
- ZIP Code
- 08527
- Phone
- (732) 367-6600
Authorized Official
- Name
- ANDROVSKY ALBERTO LUGO, ESQ.
- Title
- GENERAL COUNSEL/EXECUTIVE VICE PRES
- Phone
- (201) 242-4006
Specialties & Taxonomy Codes
| Specialty |
|---|
| Assisted Living Facility |
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