Provider Demographics
NPI:1790116929
Name:GRACE ELDERCARE LLC
Entity Type:Organization
Organization Name:GRACE ELDERCARE LLC
Other - Org Name:WESTWIND MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVARES
Authorized Official - Suffix:
Authorized Official - Credentials:CALA
Authorized Official - Phone:973-827-6575
Mailing Address - Street 1:25 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07416-1483
Mailing Address - Country:US
Mailing Address - Phone:973-827-6575
Mailing Address - Fax:973-209-3403
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NJ
Practice Address - Zip Code:07416-1483
Practice Address - Country:US
Practice Address - Phone:973-827-6575
Practice Address - Fax:973-209-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ19C002310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility