Healthcare Provider Details

I. General information

NPI: 1134182934
Provider Name (Legal Business Name): LINCOLN PARK CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 PINE BROOK RD
LINCOLN PARK NJ
07035-1804
US

IV. Provider business mailing address

499 PINE BROOK RD
LINCOLN PARK NJ
07035-1804
US

V. Phone/Fax

Practice location:
  • Phone: 973-696-3300
  • Fax: 973-633-8747
Mailing address:
  • Phone: 973-696-3300
  • Fax: 973-633-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061409
License Number StateNJ

VIII. Authorized Official

Name: MRS. MIMI FELICIANO
Title or Position: CEO
Credential:
Phone: 973-696-3300