Provider Demographics
NPI:1093578312
Name:AILLISE COMMUNITY HOME LLC
Entity Type:Organization
Organization Name:AILLISE COMMUNITY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AILLISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONHOMME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-252-1495
Mailing Address - Street 1:801 GALLERIA DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-6343
Mailing Address - Country:US
Mailing Address - Phone:862-251-1495
Mailing Address - Fax:
Practice Address - Street 1:5051 ROUTE 42
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-1779
Practice Address - Country:US
Practice Address - Phone:856-885-0558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging