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General NPI Number Information
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NPI Number | 1750454005
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Entity Type | Organization
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Legal Business Name | ST. BARNABAS ASSISTED LIVING AT LAKEWOOD
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 77 WILLIAMS ST
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4728
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Country | US
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Telephone | 973-450-2942
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Fax |
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Provider Business Mailing Address
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Address Line | 77 WILLIAMS ST
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4728
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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 | V.P. FINANCIAL OPERATIONS
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Name | GENNARO ROTELLA
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Credential |
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Telephone | 973-450-2942
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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 | 65A103
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License Number State | NJ
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