Provider Demographics
NPI:1396884672
Name:CHESHIRE HOME INC
Entity type:Organization
Organization Name:CHESHIRE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEITLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-966-1232
Mailing Address - Street 1:9 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2329
Mailing Address - Country:US
Mailing Address - Phone:973-966-1232
Mailing Address - Fax:973-966-6153
Practice Address - Street 1:9 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2329
Practice Address - Country:US
Practice Address - Phone:973-966-1232
Practice Address - Fax:973-966-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061421314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4492005Medicaid
NJ315383Medicare ID - Type UnspecifiedMEDICARE NUMBER