Healthcare Provider Details

I. General information

NPI: 1760666150
Provider Name (Legal Business Name): 290 RED SCHOOL LANE ALF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 RED SCHOOL LN
PHILLIPSBURG NJ
08865-2276
US

IV. Provider business mailing address

101 E STREET RD
KENNETT SQUARE PA
19348-1701
US

V. Phone/Fax

Practice location:
  • Phone: 908-859-2800
  • Fax: 908-859-4532
Mailing address:
  • Phone: 610-925-4436
  • Fax: 610-925-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number953335
License Number StateNJ

VIII. Authorized Official

Name: MARCELLA WILKINSON
Title or Position: CORPORATE DIRECTOR
Credential:
Phone: 610-925-4045