OrganizationActive
11 History Lane Operating Company, LLC
NPI 1073170072 · Assisted Living Facility · Jackson, NJ
Provider details
- NPI number
- 1073170072
- Entity type
- Organization
- Primary specialty
- Assisted Living FacilityNursing & Custodial Care Facilities
- Authorized official
- Androvsky Lugo, General Counsel/Executive Vice Pres
Practice location
11 History Lane
Jackson, NJ 08527
Phone: (732) 367-6600
Fax: (732) 905-9641
Mailing address
11 History Lane
Jackson, NJ 08527
Registry dates
- Enumerated
- 2019-05-24
- Last updated
- 2019-05-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.