Provider Demographics
NPI:1578789426
Name:BEAR CREEK ASSISTED LIVING
Entity Type:Organization
Organization Name:BEAR CREEK ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-918-1075
Mailing Address - Street 1:291 VILLAGE RD E
Mailing Address - Street 2:
Mailing Address - City:WEST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-2425
Mailing Address - Country:US
Mailing Address - Phone:609-918-1075
Mailing Address - Fax:609-918-1095
Practice Address - Street 1:291 VILLAGE RD E
Practice Address - Street 2:
Practice Address - City:WEST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08550-2425
Practice Address - Country:US
Practice Address - Phone:609-918-1075
Practice Address - Fax:609-918-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ8HEV7E3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9097601Medicaid