Bristol Glen, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

85A001 Issued in NJ

Legal business name

BRISTOL GLEN, INC.

Practice address

200 Bristol Glen Drive
Newton, NJ 07860

Phone

(973) 300-5788

NPI assigned

Apr 20, 2015

Last updated

Oct 30, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert Peterson

Title

Chief Financial Officer

Phone

(732) 922-2980

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Bristol Glen Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bristol Glen Inc

  • Skilled Nursing Facility
  • Newton, NJ
  • NPI 1588740401
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1295122075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 JUMPING BROOK RD",
            "city": "NEPTUNE",
            "state": "NJ",
            "postal_code": "077533197",
            "telephone_number": "732-922-9800",
            "fax_number": "732-922-9804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BRISTOL GLEN DRIVE",
            "city": "NEWTON",
            "state": "NJ",
            "postal_code": "07860",
            "telephone_number": "973-300-5788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL GLEN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-20",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "732-922-2980",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NJ",
            "license": "85A001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4504003",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gina Bradley, LCSW
• Lori Bravenboer, FNP
• Bridgeway Behavioral Health Services
• Bridgeway Behavioral Health Services
• Bristol Glen Inc
• Broadstep Academy-New Jersey, Inc.
• Broadstep Academy-New Jersey, Inc.
• David Samuel Brody, DMD
• Jessica Broesler, CPRS
• Dana Brogneri, PT, DPT

• Assisted Living Facility in Newton, NJ
• Providers in Newton, NJ by specialty
• Assisted Living Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.