=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003956806
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRC REALTY CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 06/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 LAUREL AVE
-----------------------------------------------------
City | KEANSBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07734-1122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-471-1600
-----------------------------------------------------
Fax | 732-471-1077
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 LAUREL AVE
-----------------------------------------------------
City | KEANSBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07734-1122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-471-1600
-----------------------------------------------------
Fax | 732-471-1077
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR OWNER
-----------------------------------------------------
Name | MR. ANTHONY JOSEPH CAPPADONA
-----------------------------------------------------
Credential | NJCALA
-----------------------------------------------------
Telephone | 732-471-1600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 90115
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------