1942425897 NPI number — ASSISTED LIVING OF WALL TOWNSHIP, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942425897 NPI number — ASSISTED LIVING OF WALL TOWNSHIP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSISTED LIVING OF WALL TOWNSHIP, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1942425897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2018 STATE ROUTE 35
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING LAKE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07762-2558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-282-1014
Provider Business Mailing Address Fax Number:
732-282-1050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2018 STATE ROUTE 35
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING LAKE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07762-2558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-282-1014
Provider Business Practice Location Address Fax Number:
732-282-1050
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RENEHAN
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
732-282-1014

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  1EGWIO , 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: 8608806 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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