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General NPI Number Information
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NPI Number | 1548387285
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Entity Type | Organization
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Legal Business Name | CA FANWOOD LLC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 295 SOUTH AVE
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City | FANWOOD
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State | NJ
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Zip | 07023-1357
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Country | US
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Telephone | 908-654-5200
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Fax | 908-789-0451
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Provider Business Mailing Address
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Address Line | 33 UNION PL 2ND FLOOR
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City | SUMMIT
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State | NJ
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Zip | 07901-3650
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Country | US
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Telephone | 908-522-0808
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Fax | 908-522-5565
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Authorized Official
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Title or Position | CFO
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Name | MS. DEENA B SCHAFFER
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Credential |
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Telephone | 908-522-0808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 90A000
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License Number State | NJ
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