Provider Demographics
NPI:1134262959
Name:BUCKINGHAM PLACE ASSISTED LIVING
Entity type:Organization
Organization Name:BUCKINGHAM PLACE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VLECIDES,II
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-329-8888
Mailing Address - Street 1:155 RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-9608
Mailing Address - Country:US
Mailing Address - Phone:732-329-8888
Mailing Address - Fax:732-329-8813
Practice Address - Street 1:155 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-9608
Practice Address - Country:US
Practice Address - Phone:732-329-8888
Practice Address - Fax:732-329-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJLHR4HN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8723401Medicaid