Provider Demographics
NPI:1851670426
Name:FANWOOD SENIOR CARE, LLC
Entity Type:Organization
Organization Name:FANWOOD SENIOR CARE, LLC
Other - Org Name:THE CHELSEA AT FANWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-889-4200
Mailing Address - Street 1:295 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1357
Mailing Address - Country:US
Mailing Address - Phone:908-654-5200
Mailing Address - Fax:908-789-0451
Practice Address - Street 1:295 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1357
Practice Address - Country:US
Practice Address - Phone:908-654-5200
Practice Address - Fax:908-789-0451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMG CHELSEA SENIOR CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ90A000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility