Healthcare Provider Details

I. General information

NPI: 1639170657
Provider Name (Legal Business Name): MARGARET MCLAUGHLIN MCCARRICK CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 DELLWOOD LN
SOMERSET NJ
08873-1551
US

IV. Provider business mailing address

15 DELLWOOD LN
SOMERSET NJ
08873-1551
US

V. Phone/Fax

Practice location:
  • Phone: 732-545-4200
  • Fax: 732-846-1089
Mailing address:
  • Phone: 732-545-4200
  • Fax: 732-846-1089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061812
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number061812
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number061812
License Number StateNJ

VIII. Authorized Official

Name: MR. JAMES F. CARON
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 732-545-4200