Healthcare Provider Details

I. General information

NPI: 1003956806
Provider Name (Legal Business Name): TRC REALTY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 LAUREL AVE
KEANSBURG NJ
07734-1122
US

IV. Provider business mailing address

7 LAUREL AVE
KEANSBURG NJ
07734-1122
US

V. Phone/Fax

Practice location:
  • Phone: 732-471-1600
  • Fax: 732-471-1077
Mailing address:
  • Phone: 732-471-1600
  • Fax: 732-471-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number90115
License Number StateNJ

VIII. Authorized Official

Name: MR. ANTHONY JOSEPH CAPPADONA
Title or Position: ADMINISTRATOR OWNER
Credential: NJCALA
Phone: 732-471-1600