Provider Demographics
NPI:1992845150
Name:CARERET SENIOR LIVING
Entity Type:Organization
Organization Name:CARERET SENIOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR LTC ACCOUNTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-206-8003
Mailing Address - Street 1:1155 E JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2310
Mailing Address - Country:US
Mailing Address - Phone:908-352-9200
Mailing Address - Fax:
Practice Address - Street 1:1155 E JERSEY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2310
Practice Address - Country:US
Practice Address - Phone:908-352-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ90A120310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0009229Medicaid