=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528292224
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONASTERY RESIDENCES, LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2009
-----------------------------------------------------
Last Update Date | 05/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 CROSSWICKS ST
-----------------------------------------------------
City | BORDENTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08505-1740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-298-9960
-----------------------------------------------------
Fax | 609-298-5527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 CROSSWICKS ST
-----------------------------------------------------
City | BORDENTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08505-1740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-298-9960
-----------------------------------------------------
Fax | 609-298-5527
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. CHRISTINA FOGLIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-298-2229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | J6TDGC
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------