MEDICARE: ASSISTED LIVING, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1063998060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSISTED LIVING, INC.

Provider Business Mailing Address
First Line	:	1008 RIVER RD
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08628-2101
Country	:	US
Telephone Number	:	609-432-4430
Fax Number	:	609-883-8503

Provider Business Practice Location Address
First Line	:	1266 RIVER RD REAR
Second Line	:
City	:	TITUSVILLE
State	:	NJ
Zip	:	08560-1603
Country	:	US
Telephone Number	:	609-432-4430
Fax Number	:	609-883-8503

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	REBECCA LYNN
Credential	:
Telephone Number	:	609-432-4430

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	07/13/2018

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