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General NPI Number Information
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NPI Number | 1578892840
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Entity Type | Organization
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Legal Business Name | METSUN JACKSON NJ SENIOR LIVING, LLC
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 7900 WESTPARK DR SUITE T-900
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City | MC LEAN
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State | VA
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Zip | 22102-4242
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Country | US
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Telephone | 732-928-5600
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Fax | 732-928-5601
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Provider Business Mailing Address
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Address Line | 7900 WESTPARK DR SUITE T-900
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City | MC LEAN
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State | VA
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Zip | 22102-4242
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ROBYN MAJA BURNS
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Credential | CALA
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Telephone | 732-928-5600
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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 | 15A112
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License Number State | NJ
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