Healthcare Provider Details

I. General information

NPI: 1497225940
Provider Name (Legal Business Name): SHP V MIDDLETOWN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 STATE ROUTE 35
MIDDLETOWN NJ
07748-6400
US

IV. Provider business mailing address

7 GIRALDA FARMS C/ O PGIM REAL ESTATE
MADISON NJ
07940
US

V. Phone/Fax

Practice location:
  • Phone: 732-571-4814
  • Fax:
Mailing address:
  • Phone: 973-734-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY ROBESON
Title or Position: AUTHORIZED DESIGNEE
Credential:
Phone: 973-734-1345