Healthcare Provider Details

I. General information

NPI: 1831232263
Provider Name (Legal Business Name): MSH WEST ESSEX OPERATING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 GREENBROOK RD
FAIRFIELD NJ
07004-3890
US

IV. Provider business mailing address

47 GREENBROOK RD
FAIRFIELD NJ
07004-3890
US

V. Phone/Fax

Practice location:
  • Phone: 973-228-7890
  • Fax:
Mailing address:
  • Phone: 973-228-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number30A003
License Number StateNJ

VIII. Authorized Official

Name: RICHARD CAMINITI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-228-7890