Provider Demographics
NPI:1356621429
Name:MONTVILLE SENIOR CARE, LLC
Entity type:Organization
Organization Name:MONTVILLE SENIOR CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-889-4200
Mailing Address - Street 1:165 CHANGEBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9563
Mailing Address - Country:US
Mailing Address - Phone:973-402-1100
Mailing Address - Fax:973-402-4132
Practice Address - Street 1:165 CHANGEBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9563
Practice Address - Country:US
Practice Address - Phone:973-402-1100
Practice Address - Fax:973-402-4132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CMG CHELSEA SENIOR CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ031446310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility