Provider Demographics
NPI:1922434158
Name:STRATEGIC LONG TERM CARE OF NEW JERSEY AT DELAIRE LLC
Entity Type:Organization
Organization Name:STRATEGIC LONG TERM CARE OF NEW JERSEY AT DELAIRE LLC
Other - Org Name:DELAIRE GARDENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LNHA
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PILEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-862-3399
Mailing Address - Street 1:400 W STIMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4434
Mailing Address - Country:US
Mailing Address - Phone:908-862-3399
Mailing Address - Fax:
Practice Address - Street 1:400 W STIMPSON AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4434
Practice Address - Country:US
Practice Address - Phone:908-862-3399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STRATEGIC LONG TERM CARE OF NEW JERSEY AT DELAIRE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-19
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ90C000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4504917Medicaid