Provider Demographics
NPI:1093891988
Name:PATRICIA ROGERS, LLC
Entity Type:Organization
Organization Name:PATRICIA ROGERS, LLC
Other - Org Name:SHORE MEDICAL BEHAVIORAL COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:908-278-3688
Mailing Address - Street 1:42 ARBUTUS AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-5528
Mailing Address - Country:US
Mailing Address - Phone:908-278-3688
Mailing Address - Fax:732-477-4460
Practice Address - Street 1:42 ARBUTUS AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-5528
Practice Address - Country:US
Practice Address - Phone:908-278-3688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ000669003104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0070190Medicaid
NJ086351V2MMedicare Oscar/Certification
NJ107255Medicare PIN
NJ0070190Medicaid