Provider Demographics
NPI:1568761302
Name:MERRY HEART ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:MERRY HEART ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANQUITA
Authorized Official - Middle Name:MONTILLA
Authorized Official - Last Name:BONIFACIO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LNHA
Authorized Official - Phone:973-584-4000
Mailing Address - Street 1:118 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1316
Mailing Address - Country:US
Mailing Address - Phone:973-584-4000
Mailing Address - Fax:973-584-2717
Practice Address - Street 1:118 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1316
Practice Address - Country:US
Practice Address - Phone:973-584-4000
Practice Address - Fax:973-584-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14A002310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility