Provider Demographics
NPI:1003956806
Name:TRC REALTY CORP
Entity Type:Organization
Organization Name:TRC REALTY CORP
Other - Org Name:BAYSIDE MANOR ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CAPPADONA
Authorized Official - Suffix:
Authorized Official - Credentials:NJCALA
Authorized Official - Phone:732-471-1600
Mailing Address - Street 1:7 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:KEANSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-1122
Mailing Address - Country:US
Mailing Address - Phone:732-471-1600
Mailing Address - Fax:732-471-1077
Practice Address - Street 1:7 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734-1122
Practice Address - Country:US
Practice Address - Phone:732-471-1600
Practice Address - Fax:732-471-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ90115310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7279001Medicaid