1861500563 NPI number — CPL BEY LEA LLC

Table of content: (NPI 1861500563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861500563 NPI number — CPL BEY LEA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CPL BEY LEA 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:
BEY LEA VILLAGE CARE CENTER
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:
1861500563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2029 MORRIS AVE
Provider Second Line Business Mailing Address:
SUITE # 2
Provider Business Mailing Address City Name:
UNION
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07083-6013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-686-3233
Provider Business Mailing Address Fax Number:
908-686-3668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1351 OLD FREEHOLD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08753-2775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-240-0090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LINTEAU
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CONTRACT MANAGER
Authorized Official Telephone Number:
908-686-3233

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  65C000 , 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: 0079511 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com