Healthcare Provider Details

I. General information

NPI: 1962520593
Provider Name (Legal Business Name): CA MONTVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CHANGEBRIDGE RD
MONTVILLE NJ
07045-9563
US

IV. Provider business mailing address

33 UNION PL 2ND FL
SUMMIT NJ
07901-3650
US

V. Phone/Fax

Practice location:
  • Phone: 973-402-1100
  • Fax: 973-402-4132
Mailing address:
  • Phone: 908-522-0808
  • Fax: 908-522-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number59E97L
License Number StateNJ

VIII. Authorized Official

Name: MS. DEENA B SCHAFFER
Title or Position: CFO
Credential:
Phone: 908-522-0808