Provider Demographics
NPI:1730771650
Name:SJV 1 FLORHAM PARK OPCO LLC
Entity type:Organization
Organization Name:SJV 1 FLORHAM PARK OPCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR REIMBURSEMENT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-854-0830
Mailing Address - Street 1:21 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2336
Mailing Address - Country:US
Mailing Address - Phone:973-966-8999
Mailing Address - Fax:973-966-8998
Practice Address - Street 1:21 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2336
Practice Address - Country:US
Practice Address - Phone:973-966-8999
Practice Address - Fax:973-966-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0919110Medicaid