Provider Demographics
NPI:1497505614
Name:WG CRANFORD SH LLC
Entity Type:Organization
Organization Name:WG CRANFORD SH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR SUPPORT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-779-7341
Mailing Address - Street 1:300 E MARKET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1968
Mailing Address - Country:US
Mailing Address - Phone:502-779-7341
Mailing Address - Fax:
Practice Address - Street 1:10 JACKSON DR
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3602
Practice Address - Country:US
Practice Address - Phone:908-709-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility