Provider Demographics
NPI:1023364502
Name:PAVILIONS AT FORRESTAL
Entity Type:Organization
Organization Name:PAVILIONS AT FORRESTAL
Other - Org Name:ATRIUM AT PRINCETON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVANAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-694-2100
Mailing Address - Street 1:5000 WINDROW DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5003
Mailing Address - Country:US
Mailing Address - Phone:609-987-1221
Mailing Address - Fax:609-987-0619
Practice Address - Street 1:5000 WINDROW DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5003
Practice Address - Country:US
Practice Address - Phone:609-987-1221
Practice Address - Fax:609-987-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ62202385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0295264Medicaid