Provider Demographics
NPI:1497896526
Name:CHELSEA AT EAST BRUNSWICK
Entity Type:Organization
Organization Name:CHELSEA AT EAST BRUNSWICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PETRO
Authorized Official - Suffix:
Authorized Official - Credentials:CALA
Authorized Official - Phone:732-651-6100
Mailing Address - Street 1:606 CRANBURY RD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5422
Mailing Address - Country:US
Mailing Address - Phone:732-651-6100
Mailing Address - Fax:732-651-6446
Practice Address - Street 1:606 CRANBURY RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5422
Practice Address - Country:US
Practice Address - Phone:732-651-6100
Practice Address - Fax:732-651-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ50A000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7657901Medicaid