Provider Demographics
NPI:1720684434
Name:CSH SHREWSBURY LICENSEE, LLC
Entity Type:Organization
Organization Name:CSH SHREWSBURY LICENSEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ANDREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-747-7540
Mailing Address - Street 1:515 SHREWSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4061
Mailing Address - Country:US
Mailing Address - Phone:732-747-7540
Mailing Address - Fax:732-268-8152
Practice Address - Street 1:515 SHREWSBURY AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4061
Practice Address - Country:US
Practice Address - Phone:732-747-7540
Practice Address - Fax:732-268-8152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility