Provider Demographics
NPI:1780952671
Name:SELAH CARE CENTER A NJ NON-PROFIT ORG
Entity type:Organization
Organization Name:SELAH CARE CENTER A NJ NON-PROFIT ORG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRANQUILLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-850-0099
Mailing Address - Street 1:443 SCHOOLEYS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-4023
Mailing Address - Country:US
Mailing Address - Phone:908-850-0099
Mailing Address - Fax:908-269-8769
Practice Address - Street 1:236 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-513-5150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care