Provider Demographics
NPI:1477094472
Name:SHP V ROSELAND, LLC
Entity Type:Organization
Organization Name:SHP V ROSELAND, LLC
Other - Org Name:ARBOR TERRACE ROSELAND
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:FIORESE
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:973-618-1888
Mailing Address - Street 1:P.O. BOX 70469
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40270
Mailing Address - Country:US
Mailing Address - Phone:973-618-1888
Mailing Address - Fax:973-618-0888
Practice Address - Street 1:345 EAGLE ROCK AVENUE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068
Practice Address - Country:US
Practice Address - Phone:973-618-1888
Practice Address - Fax:973-618-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ07015310400000X
311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0593877Medicaid