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NPI Code Detail

MEDICARE: COMPLETE CARE AT SHORROCK HAVEN, LLC

MEDICARE: COMPLETE CARE AT SHORROCK HAVEN, 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
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1548817612
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMPLETE CARE AT SHORROCK HAVEN, LLC
Provider Business Mailing Address
First Line : 100 BOULEVARD OF AMERICAS
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-4585
Country : US
Telephone Number : 732-955-9047
Fax Number :
Provider Business Practice Location Address
First Line : 75 OLD TOMS RIVER RD
Second Line :
City : BRICK
State : NJ
Zip : 08723-7800
Country : US
Telephone Number : 732-451-1000
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SHALOM STEIN
Credential :
Telephone Number : 732-313-0880
Provider Enumeration Date : 08/22/2019
Last Update Date : 02/22/2022

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