Healthcare Provider Details

I. General information

NPI: 1396884672
Provider Name (Legal Business Name): CHESHIRE HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RIDGEDALE AVE
FLORHAM PARK NJ
07932-2329
US

IV. Provider business mailing address

9 RIDGEDALE AVE
FLORHAM PARK NJ
07932-2329
US

V. Phone/Fax

Practice location:
  • Phone: 973-966-1232
  • Fax: 973-966-6153
Mailing address:
  • Phone: 973-966-1232
  • Fax: 973-966-6153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061421
License Number StateNJ

VIII. Authorized Official

Name: MR. GEORGE ZEITLER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-966-1232