Provider Demographics
NPI:1497225940
Name:SHP V MIDDLETOWN LLC
Entity Type:Organization
Organization Name:SHP V MIDDLETOWN LLC
Other - Org Name:ARBOR TERRACE MIDDLETOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED DESIGNEE
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-734-1345
Mailing Address - Street 1:7 GIRALDA FARMS
Mailing Address - Street 2:C/ O PGIM REAL ESTATE
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940
Mailing Address - Country:US
Mailing Address - Phone:973-734-1345
Mailing Address - Fax:
Practice Address - Street 1:1800 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-6400
Practice Address - Country:US
Practice Address - Phone:732-571-4814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ13A303OtherASSISTED LIVING RESIDENCE