Provider Demographics
NPI:1417463662
Name:AMBER COURT AT SUFFOLK COUNTY LLC
Entity Type:Organization
Organization Name:AMBER COURT AT SUFFOLK COUNTY LLC
Other - Org Name:AMBER COURT OF SMITHTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-352-9200
Mailing Address - Street 1:1155 E JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2310
Mailing Address - Country:US
Mailing Address - Phone:908-352-9200
Mailing Address - Fax:
Practice Address - Street 1:130 LAKE AVE S
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1001
Practice Address - Country:US
Practice Address - Phone:908-352-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-26
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility