Healthcare Provider Details

I. General information

NPI: 1124384904
Provider Name (Legal Business Name): BALD EAGLE SENIOR LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 CAHILL CROSS RD
WEST MILFORD NJ
07480-1947
US

IV. Provider business mailing address

197 CAHILL CROSS RD
WEST MILFORD NJ
07480-1947
US

V. Phone/Fax

Practice location:
  • Phone: 973-728-6000
  • Fax: 973-657-1657
Mailing address:
  • Phone: 973-728-6000
  • Fax: 973-657-1657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number70A000
License Number StateNJ

VIII. Authorized Official

Name: DEENA SCHAFFER
Title or Position: MEMBER
Credential:
Phone: 908-889-4200