Provider Demographics
NPI:1750454005
Name:ST. BARNABAS ASSISTED LIVING AT LAKEWOOD
Entity Type:Organization
Organization Name:ST. BARNABAS ASSISTED LIVING AT LAKEWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. FINANCIAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GENNARO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-450-2942
Mailing Address - Street 1:77 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:77 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4728
Practice Address - Country:US
Practice Address - Phone:973-450-2942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ65A103310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8112207Medicaid