1174925572 NPI number — SHORROCK GARDENS CARE CENTER, INC.

Table of content: (NPI 1174925572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174925572 NPI number — SHORROCK GARDENS CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHORROCK GARDENS CARE CENTER, INC.
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:
THE HAVEN AT SHORROCK GARDENS
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:
1174925572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1730 RTE 37 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08757-2345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-244-1400
Provider Business Mailing Address Fax Number:
244-732-4704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 OLD TOMS RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08723-7800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-451-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
TRIOLA
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
732-244-1400

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  65A004 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7902417 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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