Healthcare Provider Details

I. General information

NPI: 1457593444
Provider Name (Legal Business Name): TAG SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 WASHINGTON ST
COLUMBIA NJ
07832-2324
US

IV. Provider business mailing address

28 WASHINGTON ST
COLUMBIA NJ
07832-2324
US

V. Phone/Fax

Practice location:
  • Phone: 908-496-4307
  • Fax:
Mailing address:
  • Phone: 908-496-4307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number62104
License Number StateNJ

VIII. Authorized Official

Name: ALVAN SMALL
Title or Position: ADMINISTRATOR
Credential:
Phone: 732-841-5483