Healthcare Provider Details

I. General information

NPI: 1447853965
Provider Name (Legal Business Name): CANELAVILLE HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 HIDDEN VILLAGE DR
PERTH AMBOY NJ
08861-3367
US

IV. Provider business mailing address

243 BROADWAY UNIT 9188
NEWARK NJ
07104-7408
US

V. Phone/Fax

Practice location:
  • Phone: 732-925-2407
  • Fax:
Mailing address:
  • Phone: 732-925-2407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: ROLFFI CANELA
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 732-925-2407