Healthcare Provider Details

I. General information

NPI: 1841783008
Provider Name (Legal Business Name): CSH NORWOOD LICENSEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 TAPPAN RD
NORWOOD NJ
07648-1226
US

IV. Provider business mailing address

300 E MARKET ST STE 100
LOUISVILLE KY
40202-1968
US

V. Phone/Fax

Practice location:
  • Phone: 201-768-0208
  • Fax:
Mailing address:
  • Phone: 502-779-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number02A026
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number02A026
License Number StateNJ

VIII. Authorized Official

Name: MR. W. BRYAN HUDSON
Title or Position: EVP, GENERAL COUNSEL, & SECRETARY
Credential:
Phone: 502-779-7663