SECOND HOME PERTH AMBOY LLC
Adult Care Home
Perth Amboy, New Jersey
Provider NPI: 1063627545
Organization Information:Organization Name: SECOND HOME PERTH AMBOY LLC
Practice Location:
420 FAYETTE ST PERTH AMBOY, NJ 08861 US
Tel: 732-826-8012 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
420 FAYETTE ST PERTH AMBOY, NJ 08861 US
Tel: 732-826-8012 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 311ZA0620X | Nursing & Custodial Care Facilities Custodial Care Facility Adult Care Home | NJ | Z0SFLR |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
7667043 | NJ | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin