Provider Demographics
NPI:1245707850
Name:ESSEX RESIDENTIAL CARE, LLC
Entity type:Organization
Organization Name:ESSEX RESIDENTIAL CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIVERSIFIED VENTURES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEMAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-751-7520
Mailing Address - Street 1:165 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6414
Mailing Address - Country:US
Mailing Address - Phone:973-226-1100
Mailing Address - Fax:973-226-5993
Practice Address - Street 1:165 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6414
Practice Address - Country:US
Practice Address - Phone:973-226-1100
Practice Address - Fax:973-226-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ315247OtherMEDICARE