Healthcare Provider Details

I. General information

NPI: 1497754188
Provider Name (Legal Business Name): CARE ONE AT MERCER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PARKWAY AVE
EWING NJ
08628-3008
US

IV. Provider business mailing address

1201 PARKWAY AVE
EWING NJ
08628-3008
US

V. Phone/Fax

Practice location:
  • Phone: 609-882-6900
  • Fax: 609-671-3910
Mailing address:
  • Phone: 609-882-6900
  • Fax: 609-671-3910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number476003
License Number StateNJ

VIII. Authorized Official

Name: MR. KEVIN P BRESLIN
Title or Position: EXECUTIVE VP
Credential:
Phone: 201-242-4004