Healthcare Provider Details

I. General information

NPI: 1942335807
Provider Name (Legal Business Name): FAMILY SENIOR HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 GARFIELD AVE FIRST FLOOR
JERSEY CITY NJ
07305
US

IV. Provider business mailing address

675 GARFIELD AVE
JERSEY CITY NJ
07305
US

V. Phone/Fax

Practice location:
  • Phone: 201-761-0280
  • Fax: 201-761-0290
Mailing address:
  • Phone: 201-761-0280
  • Fax: 201-761-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number408331
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number408331
License Number StateNJ

VIII. Authorized Official

Name: MRS. LUISA U. SANTANA
Title or Position: ADMINISTRATOR
Credential: BS, CALA, ADC
Phone: 201-761-0280