Healthcare Provider Details

I. General information

NPI: 1841287083
Provider Name (Legal Business Name): CG HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 GROVE AVE
CEDAR GROVE NJ
07009-1436
US

IV. Provider business mailing address

14 C 53RD STREET SUITE 220
BROOKLYN NY
11232-3614
US

V. Phone/Fax

Practice location:
  • Phone: 973-571-6600
  • Fax:
Mailing address:
  • Phone: 718-567-0400
  • Fax: 718-567-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number306000
License Number StateNJ

VIII. Authorized Official

Name: CHAVIE KATZ
Title or Position: SUPERVISOR
Credential:
Phone: 718-567-0400