Provider Demographics
NPI:1124384904
Name:BALD EAGLE SENIOR LIVING
Entity type:Organization
Organization Name:BALD EAGLE SENIOR LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-889-4200
Mailing Address - Street 1:197 CAHILL CROSS RD
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-1947
Mailing Address - Country:US
Mailing Address - Phone:973-728-6000
Mailing Address - Fax:973-657-1657
Practice Address - Street 1:197 CAHILL CROSS RD
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-1947
Practice Address - Country:US
Practice Address - Phone:973-728-6000
Practice Address - Fax:973-657-1657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ70A000310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility