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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:

PrimaryCodeCategory/DescriptionStateLicense Number
Y311ZA0620XNursing & Custodial Care Facilities
Custodial Care Facility
Adult Care Home
NJZ0SFLR

Other Provider Identifiers:

IssuerNumberStateType
7667043NJ05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




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