Provider Demographics
NPI:1265031314
Name:SHP VI LLC
Entity type:Organization
Organization Name:SHP VI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT- SENIOR HOUSING
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-683-1670
Mailing Address - Street 1:1050 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2905
Mailing Address - Country:US
Mailing Address - Phone:908-760-0599
Mailing Address - Fax:908-264-7780
Practice Address - Street 1:1050 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2905
Practice Address - Country:US
Practice Address - Phone:908-760-0599
Practice Address - Fax:908-264-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0735914Medicaid