1165 Easton Avenue Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

1165 EASTON AVENUE OPERATIONS LLC

Doing business as

Willow Creek Rehabilitation and Care Center

Practice address

1165 Easton Ave
Somerset, NJ 08873-1613

Phone

(732) 246-4100

Fax

(732) 246-4101

NPI assigned

Aug 24, 2015

Last updated

Apr 12, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

SUMMIT CARE LLCAs reported in NPPES

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

Authorized official

Name

Michael T Berg

Title

Assistant Secretary

Phone

(505) 468-4742

Specialties & licenses 2

Addresses

Other names 1

• Willow Creek Rehabilitation and Care Center Doing business as

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

{
    "created_epoch": "1440374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491955200000",
    "number": "1568839710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1165 EASTON AVE",
            "city": "SOMERSET",
            "state": "NJ",
            "postal_code": "088731613",
            "telephone_number": "732-246-4100",
            "fax_number": "732-246-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1165 EASTON AVE",
            "city": "SOMERSET",
            "state": "NJ",
            "postal_code": "088731613",
            "telephone_number": "732-246-4100",
            "fax_number": "732-246-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1165 EASTON AVENUE OPERATIONS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUMMIT CARE LLC",
        "enumeration_date": "2015-08-24",
        "last_updated": "2017-04-12",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4742"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Creek Rehabilitation and Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 1 Able Community LLC
• 1165 Easton Avenue Operations LLC (Willow Creek Rehabilitation Care Center)
• A Home Care
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• A True Life Somerset,LLC (A True Life Counseling)
• Naznin A-Rahim

• Skilled Nursing Facility in Somerset, NJ
• Providers in Somerset, NJ by specialty
• Skilled Nursing Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; 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.