Provider Demographics
NPI:1407413404
Name:MONTCLAIR CARE CENTER LLC
Entity Type:Organization
Organization Name:MONTCLAIR CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:USHER
Authorized Official - Middle Name:
Authorized Official - Last Name:EGERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-746-4616
Mailing Address - Street 1:111-115 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111-115 GATES AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2500
Practice Address - Country:US
Practice Address - Phone:973-746-4616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility