Provider Demographics
NPI:1700279932
Name:2ND HOME EAST ORANGE LLC
Entity Type:Organization
Organization Name:2ND HOME EAST ORANGE LLC
Other - Org Name:2ND HOME EAST ORANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-395-0555
Mailing Address - Street 1:494 BROAD ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-3229
Mailing Address - Country:US
Mailing Address - Phone:973-395-0555
Mailing Address - Fax:
Practice Address - Street 1:115 EVERGREEN PL
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2020
Practice Address - Country:US
Practice Address - Phone:973-676-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ308113261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ308113OtherSTATE LICENSE NUMBER