Healthcare Provider Details

I. General information

NPI: 1174057764
Provider Name (Legal Business Name): SHI-II HILLSBOROUGH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 ROUTE 206
HILLSBOROUGH NJ
08844-4651
US

IV. Provider business mailing address

100 JERICHO QUADRANGLE SUITE 142
JERICHO NY
11753-2708
US

V. Phone/Fax

Practice location:
  • Phone: 908-829-3157
  • Fax: 908-829-3163
Mailing address:
  • Phone: 516-496-1505
  • Fax: 516-496-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. RAYMOND T DIOGUARDI
Title or Position: COO - CFO
Credential:
Phone: 516-496-1505