Provider Demographics
NPI:1548387285
Name:CA FANWOOD LLC
Entity Type:Organization
Organization Name:CA FANWOOD LLC
Other - Org Name:THE CHELSEA AT FANWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-522-0808
Mailing Address - Street 1:33 UNION PL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3650
Mailing Address - Country:US
Mailing Address - Phone:908-522-0808
Mailing Address - Fax:908-522-5565
Practice Address - Street 1:295 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1357
Practice Address - Country:US
Practice Address - Phone:908-654-5200
Practice Address - Fax:908-789-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ90A000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7891903Medicaid