1861106148 NPI number — HILLSBORO SNF OPERATIONS, LLC

Table of content: (NPI 1861106148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861106148 NPI number — HILLSBORO SNF OPERATIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILLSBORO SNF OPERATIONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HILLSBORO HEALTH & REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861106148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1777 AVENUE OF THE STATES STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-4779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-366-8300
Provider Business Mailing Address Fax Number:
732-523-5312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1778 NE CORNELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97124-2740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-648-6621
Provider Business Practice Location Address Fax Number:
432-523-5312
Provider Enumeration Date:
01/11/2023

Additional Information

Authorized Official

Authorized Official Last Name:
YENOWITZ
Authorized Official First Name:
YITZCHOK
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED REPRESENTATIVE
Authorized Official Telephone Number:
323-333-0910

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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