=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316920572
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVINGSTON CARE CENTER LIMITED PARTNERSHIP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2005
-----------------------------------------------------
Last Update Date | 04/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 S LIVINGSTON AVE
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-3927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-994-0221
-----------------------------------------------------
Fax | 973-992-0696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 S LIVINGSTON AVE
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-3927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-994-0221
-----------------------------------------------------
Fax | 973-992-0696
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTROLLER
-----------------------------------------------------
Name | MRS. MICHELE M CAGGIANO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-994-0221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 060708
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------