Provider Demographics
NPI:1326432022
Name:PAXXON HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:PAXXON HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:WINSOME
Authorized Official - Middle Name:O
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:610-991-2034
Mailing Address - Street 1:60 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3220
Mailing Address - Country:US
Mailing Address - Phone:908-309-6642
Mailing Address - Fax:732-722-8082
Practice Address - Street 1:60 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3220
Practice Address - Country:US
Practice Address - Phone:908-309-6642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAXXON HEALTHCARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40-QA00471300314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ105502498OtherNPI