Provider Demographics
NPI:1659779221
Name:SENIOR SKIN CARE, LLC
Entity Type:Organization
Organization Name:SENIOR SKIN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-391-2548
Mailing Address - Street 1:198 CHANGEWATER ROAD
Mailing Address - Street 2:PO BOX 14
Mailing Address - City:CHANGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07831
Mailing Address - Country:US
Mailing Address - Phone:908-391-2548
Mailing Address - Fax:
Practice Address - Street 1:198 CHANGEWATER ROAD
Practice Address - Street 2:
Practice Address - City:CHANGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07831
Practice Address - Country:US
Practice Address - Phone:908-391-2548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA066807000311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home