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NPI Code Detail

MEDICARE: ESSEX RESIDENTIAL CARE, LLC

MEDICARE: ESSEX RESIDENTIAL CARE, LLC
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
1314000000XSkilled Nursing Facility

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1315247OTHERNJMEDICARE

General Provider Information

NPI Number : 1245707850
Entity Type Code : Organization
Provider Name (Legal Business Name) : ESSEX RESIDENTIAL CARE, LLC
Provider Business Mailing Address
First Line : 165 FAIRFIELD AVE
Second Line :
City : WEST CALDWELL
State : NJ
Zip : 07006-6414
Country : US
Telephone Number : 973-226-1100
Fax Number : 973-226-5993
Provider Business Practice Location Address
First Line : 165 FAIRFIELD AVE
Second Line :
City : WEST CALDWELL
State : NJ
Zip : 07006-6414
Country : US
Telephone Number : 973-226-1100
Fax Number : 973-226-5993
Authorized Official
Title or Position : PRESIDENT DIVERSIFIED VENTURES
Name : MR. JOSEPH M LEMAIRE
Credential :
Telephone Number : 732-751-7520
Provider Enumeration Date : 11/01/2018
Last Update Date : 06/27/2019

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Directions to “ESSEX RESIDENTIAL CARE, LLC ” Practice Location

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